Commission on Improving First Responder Interactions with Persons with Disabilities Commission applicationPlease answer the following questions to the best of your ability.Basic informationName(Required) First Last Date of birth(Required) MM slash DD slash YYYY Gender identityFemaleMaleNonbinaryOtherEmail(Required) Phone(Required)Preferred contact method Phone Email Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employment and community involvementAre you currently employed?(Required)YesNoWho is your employer? How long have you worked for this employer? What is your title? Brief description of rolePast employment(Required)Please upload a resumeMax. file size: 128 MB.Community involvement activities (organization and role)(List past and present)Education historyList educational institutions attended and any degrees receivedAdvocacy categoryPlease select one of the following if it applies to you A person with a disability A person with a child with a disability Employed by an organization who advocates for people with disabilities (please identify which organization in your resume) Employed at a statewide organization of current or former peace officers Employed at a statewide organization of chiefs of police Employed at a statewide organization of county sheriffs Serves on the POST Board Serves on POST Board’s curriculum subject matter expert committee How much time are you capable of committing to the Commission per month? Why do you wish to serve on this Commission?(Required)8. What do you believe a successful outcome of the Commission on Improving First Responder Interactions with Persons with Disabilities would be?(Required)9. How would you describe your approach to working with individuals from different perspectives than yours?(Required)Are you a party to a legal proceeding that would adversely impact your qualifications?(Required)YesNoDo you acknowledge that CORA will apply to application and activities if appointed?(Required)YesNoReferencesPlease upload a file containing three references, including their name, phone number, email address, and relationship to you.Max. file size: 128 MB.Is there anything in your past that will negatively reflect on the Commission or the Department of Law?
