Disability-Lived Experience Panel Sign-up

Disability-Lived Experience Panel

Participation Form
Name*

First NameLast Name
Email*
example@example.com
Have you completed the Service & Leadership Interest Form on the disABILITYsa website?*

YesNoUnsure

Lived Experience & Opportunity Interests
Thank you for your interest in participating on a disability-lived experience panel with disABILITYsa.

You've indicated that you have either not completed or are unsure about completing the Service & Leadership Participation Form.

Please visit us online at https://www.disabilitysa.org/my-experience and complete the form before signing up for an opportunity. Thank you!
disABILITYsa brings together a panel of volunteers with a wide range of disabilities and typically includes only one panelist per disability category for each opportunity, unless the opportunity specifically has need for multiple panelists with similar disabilities. Selection for any panel is based on factors such as order of registration, type of disability, and how closely a volunteer’s experience aligns with the goals of that opportunity, so registering your interest does not guarantee you will be selected to participate in a particular panel.
Please select the option below that you most closely identify with:*

I am a person with a disabilityI am the parent of a child with a disabilityI am the caregiver of a person with a disabilityI am a service provider in the disability industryI am a disability ally and/or advocate
Which of the following best describes your primary disability category? (Please choose the one that most closely fits your experience. You will have an opportunity to share more detail later.)*

Physical disability (mobility, limb difference, neuromuscular condition)Blind or low visionDeaf or hard of hearingIntellectual or developmental disabilityAutismLearning disability (e.g., dyslexia, dysgraphia)Mental health or psychosocial disabilityChronic illness or other health condition (e.g., epilepsy, diabetes, autoimmune condition)Brain injury (acquired or traumatic)Other
To help us build panels that reflect a broad range of lived experiences, please describe your disability as specifically as you feel comfortable. If you identified with more than one disability, please list each one separately.*
(for example, “spinal cord injury – paraplegia,” “autism,” “bipolar disorder,” “low vision,” “Deaf ASL user,” “intellectual disability,” “chronic pain condition,” “multiple disabilities,” etc.).
Please select the opportunities you are interested in:*
Please describe your relevant experience that would make you a great participant for each opportunity you've selected. *
Should be Empty:

Disability-Lived Experience Panel

Lived Experience & Opportunity Interests