Application for Participation

Year 22 Training Dates:
November 15-16, 2013--Governors Inn, Pierre, SD--History/People 1st Language
December 13-14, 2013--Holiday Inn Express, Ft. Pierre, SD--Person Centered Thinking/Inclusive Education
January 23-25, 2014--Holiday Inn Express, Ft. Pierre,SD--Legislature
February 21-22, 2014--Holiday Inn Express, Ft. Pierre, SD--Local Gov't/Assistive Technology/Self-Advocacy/Meetings
March 21-22, 2014--Holiday Inn Express, Ft. Pierre, SD--SD--Social Security, Abuse/Neglect
April 25-26, 2014--Ramkota Hotel, Sioux Falls,SD--Employment/Inclusive Community

Name: *
Email Address: *
Mailing Address: *
City: *
State: *
Zip Code: *
County: *
Home Phone: *
Work/Alternative Phone:
Question 1 (click here to see definition of developmental disabilities)
Are you a parent of a son or daughter with a developmental disability?: *
If Yes, child/children ages:
Date of onset of child's disability:

Describe the disability and how it affects the ability of your son/daughter to function in at least three of the areas of major life activity ("D" of definition):

What services (school, respite care, case management) is your son/daughter currently receiving?:

Describe your child's school placement:
Question 2
Do you have other children?: *
Question 3
Are you a person with a disability?: *
Your Age:
Date of onset of disability:

Briefly explain your disability:
Question 4
Why are you interested in participating in the Partners in Policymaking program?:

Is there a specific issue, area of concern, or problem that encouraged you to apply for this program?:
Question 5
Will you make a time commitment of two days (Friday and Saturday), one weekend per month, from November 2013 through April 2014? ATTENDANCE AT ALL SESSIONS IS MANDATORY.: *

If employed, will your employer release you to attend Partners sessions?: *
Question 6
Are there any accommodations necessary for you to participate in this program?: *
If Yes, check which of the following accommodations will be necessary for you to participate?: Accessibility Interpreters Respite Care Alternative formats of learning materials Personal Care Attendant Other

If Accessibility, please describe your needs:
If Personal Care Attendant, please indicate who will be attending with you:
If Other, please specify:
Question 7
Do you currently belong to any advocacy organizations?: *
If Yes, please list organizations and offices held. Membership is not a requirement.:
Question 8
Please tell us a little about yourself and your family:

Please indicate how you learned about Partners in Policymaking:
Letter of Recommendation
A letter of recommendation must accompany this application. Letter of Recommendation form can be found here.
Inquiries?
Inquiries can be directed to: Sandy Stocklin Hook, Partners Coordinator SD Advocacy Services 221 S. Central Ave. Pierre, SD 57501 Voice and TDD: 800-658-4782 or 605-224-8294 Email: hooks@sdadvocacy.com

Priorities SD Report Publications Training

Partners in Policymaking

Program Graduate Accomplishments Application for Participation Developmental Disability Definition Recommendation Form Letter Testimonials

Video Employment Events Intake Form Election Info

Contact

221 South Central Ave., Ste. 38
Pierre, SD 57501
(605) 224-8294 (Voice/TTY)
1-800-658-4782 (Voice/TTY)
Fax: (605) 224-5125
Email Us

Field offices:

Rapid City: 605-342-2575
Sioux Falls: 605-361-7438
Yankton: 605-665-5616

Priorities SD Report Publications Training Video Employment Events Intake Form Election Info

This site offers legal information from a variety of sources. South Dakota Advocacy Services makes every effort to ensure the accuracy of the information. This site is not intended to provide legal advice - the application of the law to your individual circumstances. For legal advice, you should consult an attorney.