NDDPI - Application for Consideration for Appointment to the IDEA Advisory Committee

Application for Consideration for Appointment to the IDEA Advisory Committee

Office of Specially Designed Services
Name*

First NameLast Name
Address*

Street Address

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CityState

Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
The membership of the Panel shall consist of representatives from public and private sectors who, by virtue of their position, interest, and training, can contribute to the education of children with disabilities. A majority (51%) of the members of the Panel must be individuals with disabilities or parents of children with disabilities (ages birth – 26 years). To ensure that membership requirements are met, please check the category or categories that apply:

A parent of a child(ren) with a disability(ies) who is eligible under IDEA 2004(ages birth through 26)An individual with disabilitiesA teacherAn administrator of programs for children with disabilitiesA State of local education officials who carry out activities under subtitle B of Title VII of the McKinney-Vento Homeless Assistance ActA representative of an institution of higher education that prepares special education and related service personnelA representative of other State agencies involved in financing or delivery of related services to children with disabilitiesA representative from a State child welfare agency responsible for foster careA representative of a vocational, community, or business organization concerned with the provision of transition servicesA representative from a State juvenile and adult corrections agencyA representative of private schools and public charter schools
Please explain why you are interested in being a member of the Special Education Advisory Committee. Include any information regarding your special interests, skills, background, training, or personal experience that can contribute to the education of students with disabilities.*
This information is used solely to ensure the IDEA Advisory Committee comprises members reflecting the entire state of North Dakota and its community. This question is voluntary. Ethinicity (check one or more that apply)

WhiteHispanic or LatinoBlack or African AmericanNative American or American IndianAsian/Pacific IslanderMulti-racialPrefer not to answerOther
Meetings are held virtually from 9:00 a.m. - 4:00 p.m. The committee meets in September, December, and March. Would you be able to commit time to attending three meetings during the school year?*

YesNo
I submit this application with the understanding that a panel membership term is three years. If I am selected for membership, I will be expected to attend and participate in all panel meetings during my three-year term.
Signature*

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Date*

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