Part 1: Contact Information and Demographics

Included in this section is your contact information and demographic information.

The demographic information collected through this secure form will be (a) used to ensure a diverse class is selected and (b) summarized and given to funders.

If you need accommodations to complete and/or submit this application, contact Disability Rights Oregon at partners@droregon.org. 

 

Part 2: Applicant Eligibility Information

You must be in one of the following four eligible groups of participants:

1. A person with a disability who's daily life is affected by their disability. This includes intellectual or developmental disability, traumatic brain injury, or other lifelong disability that affect daily life. 
2. A parent of a child with a developmental disability, traumatic brain injury, or other lifelong disability that affects their daily life. 
3. A sibling of a person with a developmental disability, traumatic brain injury, or other lifelong disability that affects their daily life. 
4. Legal guardian (family member or non-family member) or supporter of a person with a disability in Supported Decision-Making? The disability must be a developmental disability, traumatic brain injury, or other lifelong disability that affects their daily life. 

It’s possible you might qualify under more than one category (for example, as a parent of a person with a developmental disability, you might also be a person with a devlopmental disability or a sibling). For this reason, you will be asked about each of these four categories categories. You will have space in the Getting to Know You section to provide additional information.

This information will be treated as confidential. However, summary data, including the percent of family-member participants vs. self-advocate participants, will be reported to the Fairview Trust and other funders. 

Part 3: Getting to Know You 

Please be brief with your responses.

There are no right or wrong answers! We want to get to know you.

Part 4: Accommodations and/or Supports Needed

Please tell us what supports you need to succed in the Oregon Partners in Policymaking® Leadership Series. 

Please Note: The Oregon Partners in Policymaking® Leadership Series does not provide onsite care services. However, a reimbursement allowance is provided for participants needing Financial assistance for the costs of childcare/respite services.

Please Note: The Oregon Partners in Policymaking® Leadership Series does not provide onsite services. If you answered yes to needing accommodations, language services, respite support, and/or bringing a PSW/DSP, we may follow-up one-on-one for additional information. 

Part 5: Provide References  

Please list two references (not family) that may be contacted.

Part 6: Review Participation Requirements & Signature

Participants in the Oregon Partners in Policymaking® Leadership Series will attend all advocacy training and skill-building workshops in-person. Supplemental meetings will occur virtually/online, for which you are expected to be on camera. Homework will be given for each session and MUST be completed in order to graduate. An individual project also must be completed in order to graduate. Completion of this Leadership Series training program requires a substantial commitment of time, motivation, and energy. 

If accepted into the Oregon Partners in Policymaking® Leadership Series program, I agree to:

• Attend and participate in ALL required in-person sessions. Snacks and meals will be provided and we are happy to accommodate dietary restrictions with advance notice.
• Complete all homework and class assignments.
• Complete one individual project designed to meet competencies.
• Collaborate with other learners to complete assignments & final projects.
• Complete evaluations of each session & the complete series when requested.
• Plan to stay overnight during 2-day sessions to maximize your participation, learning, and networking. 

Release & Consent

I give permission to Disability Rights Oregon and its Contractors, Vendors, and Assigns, to share the answers to the questions on this application with Oregon Partners in Policymaking® Leadership Series session leaders and members of the participant selection committee.