SILC Membership Interest Form

Date of Birth(Required)
Please enter your date of birth in MM/DD/YYYY format.
Gender(Required)
The Council is required by Federal law to have at least 51% of its members to be a person with a disability. Do you self -identify as a person with a disability?(Required)
If yes, which category best describes your primary disability:(Required)
The Council strives for its membership to represent diverse cultural groups. Please check all that apply to you:(Required)
Are you a state employee?(Required)
Are you an employee, board member, or volunteer of a Center for Independent Living?(Required)
If you are not appointed right away by the Governor’s Office, would you be willing to volunteer with the SILC in one of the areas listed below?(Required)
Please check which of the following areas you are most interested in:(Required)
Max. file size: 5 MB.
If you do not fit the SILC’s current composition needs, we will hold your application for reconsideration for no less than six months.
This field is for validation purposes and should be left unchanged.