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PAIMI Application

Thank you for your interest in the Protection and Advocacy for Individuals with Mental Illness Advisory Council (PAC). Under Federal Law, Disability Rights Ohio (DRO) as Ohio’s Protection and Advocacy System, is required to have a PAC that advises DRO on priorities (annual goals & objectives) and issues important to people receiving mental health services in Ohio, and promotes recovery through increased access to client rights and advocacy services. Sixty percent of PAC members must receive, or have previously received mental health services or be a family member of a person who receives (or received) mental health Services. All PAC members are required to live in Ohio. PAC membership is an unpaid volunteer commitment.

Please complete this online form to apply to become a member of the Disability Rights Ohio PAIMI Advisory Council. Please do not include any personally identifying information in your answers, for example your Social Security number or date of birth.

In addition to this online form, please share the recommendation form with three persons that know about your involvement with mental health issues and that can speak about your participation on other boards or councils that you have been involved with during the last two years. The letters of recommendation can be filled out online or sent to the Ohio PAIMI Advisory Council, c/o Disability Rights Ohio, 200 Civic Center Drive, Suite 300, Columbus, Ohio 43215-4234 or fax them to 614-644-1888. Your application is not considered complete and ready for review by the PAC until your completed application and 3 recommendation letters have been received.

Due to the rotating term-limits of Council members, the PAC needs to ensure that all federal requirements for membership categories are maintained at all times. Additionally, PAC strives to maintain a diverse membership including experiential, racial, cultural, geographic, gender identity, age, and disability. There are questions in this application that help us determine what diversity categories you fall into. You have the right to not answer them if you do not feel comfortable with those questions.

Download a PDF of this form here

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Must live in Ohio to be on the PAIMI Advisory Council.

* Of the above categories checked, please specify what you consider to be your primary category:

* Military/Veteran:
* Are you a current board member of advisory council for a provider of mental health services?
* If necessary, would you be able to travel to PAIMI Council meetings? Eligible travel expenses will be reimbursed, but we encourage you to notify Disability Rights Ohio if pre-paying your expenses is a barrier to your participation.

* Currently the PAC meets 4 times a year either virtually or at the Disability Rights Ohio office in Columbus. Would you be able to participate in our PAC meetings in person or virtually?

* Participation in the Council's committees is primary to ensure that the work of the Council continues. Would you be able to participate in 1 or 2 committees each month? Meetings usually last 1 hour and take place over Zoom. Committees set their own meeting times and all meet after 5 p.m.

For internal use only

By submitting this application, you understand and approve that all the information in the application and your 3 recommendations letters will be shared with the Nominating Committee and PAIMI Advisory Council to determine if you would be a good match for currently open seats on the PAIMI Advisory Council. Before a candidate is selected for appointment to the PAC, they will go through an interview with the PAC. After interview, the PAC interview team will then make a recommendation regarding appointment.

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