Indiana Direct Service Workforce Advisory Board Application
Thank you for your interest in joining the Direct Service Workers Advisory Board! The information you choose to share is only seen by the state review team, and none of the details below will prevent your application from being considered. Indiana is interested in hearing from workers across the state with diverse experiences and backgrounds. As FSSA appreciates the participation of board members in the meetings, after each board meeting a gift card is sent to board members who attend that meeting
Applicant History and Demographic Info
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address Line 2
City
State / Province
Postal / Zip Code
What languages do you speak?
*
Please separate each language with a comma.
What is your race/ethnicity?
*
What populations do you work with now? What populations have you worked with in the past?
What types of support/tasks do you usually provide?
What setting are you currently working in? What settings have you worked in in the past?
Did you receive any training for you current job?
Please Select
Yes
No
If yes, what kind of training did you receive?
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Meeting Logistics
Have you used Zoom before?
*
Please Select
Yes
No
Are you able to join Zoom meetings?
*
Please Select
Yes
No
What day of the week works best for you schedule? (Please select ALL that work for your schedule)
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What time of day works best for your schedule? (Please select ALL that work for your schedule)
*
Morning
Afternoon
Evening
Please share any other relevant information about your availability.
Are you able to commit to at leasr four meetings per year for the next two years?
*
Please Select
Yes
No
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Discussion Questions
How long have you been a direct service worker?
*
What is your favorite part about being a direct service worker?
*
What are some areas of your job where you would like to see improvement?
*
What interests you about the direct service workforce advisory group? Why do you want to be part of the group?
*
What excites you the most about participating in this project?
*
Submit
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