PAIMI Application – Alabama Disabilities Advocacy Program

PAIMI Application

PAIMI Advisory Council (PAC) Application

If you are committed to promoting the civil rights of adults and children with mental illness, we welcome your application to serve on ADAP’s Advisory Council for its PAIMI program (Protection and Advocacy for Individuals with Mental Illness).

The PAIMI Advisory Council provides ADAP with independent advice regarding the needs of Alabamians with mental illness. The Council works with ADAP’s governing board in the development of PAIMI priorities.

The Council meets in-person, virtually, or in a hybrid format. We meet at least three times per year. Members must be committed to attending Council meetings. Members are reimbursed for travel expenses to in-person meetings.

We strongly encourage applications from persons who are receiving mental health services (or have received them in the past) or family members of such persons.

If you have questions about the Council or need help filling out this application, contact us by phone at (205) 348-4928 or by email at adap@adap.ua.edu.

PAIMI Advisory Council Application

* Indicates Required Field

Applicant Name

First

Last

Applicant’s Email

Applicant’s Primary Phone

Work Phone

Applicant’s Address

Applicant's Address

City

State/Province

Zip/Postal

Birth Date

Race Race

Ethnicity

Gender Identity Gender Identity

Pronouns Pronouns

To ensure that ADAP’s Council represents a variety of lived experiences, federal law requires certain groups of persons to be members of the Council. Please check all the categories listed below that describe you:

I am a person living with a mental illness or in recovery.

I am an immediate family member of a MINOR CHILD living with an emotional disorder or in recovery.

I am an immediate family member of an ADULT living with a mental illness or in recovery.

I am a mental health professional (someone who has a license or certification to provide a mental health service like a psychiatrist, clinical psychologist, licensed social worker, certified peer support specialist, etc.)

I am an attorney.

I am a member of the public who is knowledgeable about mental illness.

I am a mental health service provider (someone whose work involves the provision of mental health services but who does not have a license or certification to provide that service).

I am employed by or represent a government or non-profit organization concerned with services for individuals with mental illness or emotional disorders.

Please tell us the name of the organization.

Why do you want to be on ADAP’s PAIMI Council?

What disability rights issues do you feel strongly about?

What would make life better for persons with MI in Alabama?

If you are human, leave this field blank.

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