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NCCDD Council Membership Application

Application for Endorsement to the Governor for Appointment to the North Carolina Council on Developmental Disabilities
(Additionally, Application for Board and Commissions (pdf) required by the Office of the Governor)
APPLICANT NAME:
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ADDRESS:
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TELEPHONE:
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BACKGROUND INFORMATION
This endorsement is for the following category:

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If parent or guardian of a child with a developmental disability, please provide child's age:
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Please tell us about yourself/the candidate. Briefly discuss how you/the candidate became interested in disability issues, and present or past involvement in disability advocacy:
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DEMOGRAPHIC INFORMATION: (optional)
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ETHNIC GROUP: (This information is helpful in endorsing applicants of culturally diverse backgrounds.)
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I WANT TO BE CONSIDERED FOR ENDORSEMENT TO THE NC COUNCIL ON DEVELOPMENTAL DISABILITIES BECAUSE:
(What skills and interests would you bring to the Council? Please keep to 1 page.)
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POSITION QUESTIONS
(Please give brief answers.)
1. What do you believe are the two or three most important issues for people with developmental disabilities and their families? Please explain.
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2. What activities should an organization such as the Council undertake to address these issues?
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Please submit this application and other requested material (resumé, vita, or personal/family history, optional) and letters of recommendation by clicking the SUBMIT button below (email address required), or you can print this document and send to the following address:
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David Ingram, Director of Operations NC Council on Developmental Disabilities
2010 Mail Service Center Raleigh, NC 27699-2010
(Voice/TDD) 984-920-8200
(Toll Free) (800) 357-6916
(FAX) (984)-920-8201

When you submit an application online, please let us know you have sent it by emailing Cora Gibson at david.ingram@dhhs.nc.gov

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North Carolina Council on Developmental Disabilities

3109 POPLARWOOD COURT, SUITE 105,
RALEIGH, NC 27604
 
1-800-357-6916 (Toll Free)
984-920-8200 (Office/TTY)
984-920-8201 (Fax)
 
This project was supported, in part by grant number 2001NCSCDD-02, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy.

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