Membership Application Form

Click here for a printable Membership Application (PDF)
Application For Membership
 
 
 
 
 
 
 
 
 

Please check either "yes" or "no" for each of the following:

I am a:

 
 
 
 
 
 
 
 
 
 
(Please note that an immediate relative or guardian of an adult with a developmental disability may only be considered for Council membership if that adult is unable to advocate for himself/herself, even with supports.)
 
 
 
 
 
 

Please respond to each of the following questions.

(Please Note: The full Council meets bi-monthly (6 times) throughout the year. In addition, members are required to serve on at least one committee, which may meet as frequently as once a month. Members are expected to review materials and information sent by Council staff in preparation for meetings.)

References

Please provide two references we can contact for a recommendation. These should be individuals who know you personally and/or professionally and would be able to comment on the strengths, skills and experience you would contribute as a member of the Council.

Reference 1

 
 
 

Reference 2

 
 
 

Please feel free to contact the Council at 207-287-4213 or 800-244-3990 if you have questions or would like additional information.