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Application for Participation

Year 32 Training Dates:

Date	Location	Topic(s)
November 17-19, 2023	AmericInn, Ft. Pierre, SD	Person Centered Thinking/History/People 1st Language
December 7-9, 2023	AmericInn, Ft. Pierre, SD	Special Education/Inclusion
January 18-20, 2024	AmericInn, Ft. Pierre, SD	Legislative
February 22-24, 2024	AmericInn, Ft. Pierre, SD	Local Gov't/Assistive Technology/Time Management/Assertiveness/Effective Meetings/Talking Circle
March 21-23, 2024	AmericInn, Ft. Pierre, SD	Social Security; Abuse/Neglect
April 26-27, 2024	Ramkota Hotel, Sioux Falls, SD	Employment/Inclusive Community

YEAR 32 APPLICATIONS ARE DUE NO LATER THAN OCTOBER 2, 2023

A word document version of this application can be found at the following link: Year 32 Partners Application - Word Document

Name: *
Required

Email Address: *
Required

Mailing Address: *
Required

City: *
Required

State: *
Required

Zip Code: *
Required

County: *
Required

Home Phone: *
Required

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?: *
Required

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?: *
Required

Question 3

Are you a person with a disability?: *
Required

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 2022 through April 2023? ATTENDANCE AT ALL SESSIONS IS MANDATORY.: *
Required

If employed, will your employer release you to attend Partners sessions?: *
Required

Question 6

Are there any accommodations necessary for you to participate in this program?: *
Required

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?: *
Required

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.

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Application for Participation

Year 32 Training Dates:

YEAR 32 APPLICATIONS ARE DUE NO LATER THAN OCTOBER 2, 2023