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Richmond Special Education Advisory Committee Membership Application
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Name
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Your answer
Date of Application
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Address
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Your answer
Home Phone
Your answer
Work Phone
Your answer
Cell Phone
Your answer
Are you a (check all that apply)
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Parent
Person with a disability
Grandparent
Guardian
Foster parent of a child/youth with a disability
Teacher
Representative of a community agency
Representative of aa community business or association
Other:
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If you are a parent or family member, what is your child's age?
Your answer
School
Your answer
Disability
Your answer
What do you hope to accomplish from your participation on the Special Education Advisory Committee?
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Your answer
What unique experiences, perspectives, talents, or skills could you bring the SEAC?
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Your answer
If invited to serve on the SEAC, what do you see as needs in special education? (List system-wide issues rather than personal issues)
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Your answer
How did you hear about the Richmond Special Education Advisory Committee? (Please check one)
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SEAC Member
Brochure
Teacher
Parent Resource Center
Other:
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