[wisconsin] application for assistive tech advisory council for WisTech due by July 1

[Katherine Schneider]

WisTech AT Advisory Council

Member Application Form

 

 

Name: ______________________________________________________

 

Address: __________________________________________________________

 

City: _______________County:__________________, WI  Zip_____________

 

Telephone: _________________________ Email: ________________________

 

 

1. Do you use assistive technology? Yes/No

 

 

 

 

2. Why would you like to be involved with the AT Council?

 

 

 

 

3. What skills would you bring to the Council?

 

 

 

 

4. We believe the AT Council should reflect the cultural diversity of people who are

consumers of AT services in Wisconsin. Please share anything about yourself that you think would add to the diversity of this council. (You might consider your diversity to be ethnic, racial, spiritual, social, economic, geographic, disability related, etc.)

 

 

 

 

 

Please use the space provided to answer the questions.

If you need additional space, please attach extra pages to this application.

 

 

WisTech AT Advisory Council

Member Application Form

 

 

 

By completing and submitting this application you agree:

 

       You are a consumer who uses AT, a family member/guardian representing a person who uses AT, or a professional who works with consumer on assistive technology issues.

 

       To provide a guiding voice for assistive technology services across the state.

 

       To participate in four one-day meetings a year at various locations throughout the state. Some meetings may be via video conference or phone. Some committee work may be involved. 

 

       To participate and share your time and expertise on sub-committees in addition to the general meetings.

 

 

Please return this form via regular mail, email or fax to:

WisTech

AT Council Recruitment

1 West Wilson, Room 438

Madison, WI 53707-7851

(608) 266-3386 Fax

Sarah.lincoln at wisconsin.gov

 

 

*If you need to submit materials orally contact Sarah Lincoln at (608) 266-7974.

 

THE DEADLINE FOR THE 2011 RECRUITMENT IS FRIDAY, July 1, 2011

Katherine Schneider, Ph.D.
Senior Psychologist, Emerita
Counseling Service
University of Wisconsin-Eau Claire
schneiks at uwec.edu 
Author of To the Left of Inspiration: Adventures in Living with Disabilities and a children's book Your Treasure Hunt: Disabilities and Finding Your Gold
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