APPLICATION PROCESS FOR GOVERNOR

APPLICATION PROCESS FOR GOVERNOR’S APPOINTMENT TO THE

OHIO DEVELOPMENTAL DISABILITIES COUNCIL

Application Requirements:

Applicants for appointment to the Ohio Developmental Disabilities Council must complete and return the following to Council office by May 1, 2007:

1. Application for Governor’s Appointment to the Ohio Developmental Disabilities Council

2. Resume or vita (preferably one page).

3. Two letters of recommendation to be sent to Council office by May 1, 2007

Further, applicants must review the State of Ohio “State Boards and Commissions Application and Questionnaire which is enclosed. Do Not Complete it Now. However, you must sign the statement indicating that you will complete the State of Ohio form if your name is being sent to the Governor by the Council.

Applicants Must Meet One of the Requirements for Council Member Representation As Specified By The DD Act:

Members appointed by the Governor must meet the requirements of one of the

following categories:

1. An individual with a developmental disability.

2. Parent or guardian of a child with a developmental disability.

3. An immediate relative or guardian of an adult with a mentally impairing developmental disability who cannot advocate for himself/herself.

4. An immediate relative or guardian of an institutionalized or previously institutionalized individual with a developmental disability or an individual with a developmental disability who resides or previously resided in an institution.

5. A representative from a county board of mental retardation/ developmental disabilities serving persons with developmental disabilities.

6. A representative from a private agency serving persons with developmental disabilities.

7. A representative from a private non-profit organization serving persons with developmental disabilities.

Important Note: Categories 1, 2, 3 and 7 are the only categories

open this year.

Process Following Submission of Application

1. The nominating Committee of Council will review information submitted by all applicants.

2. Those applicants who meet membership requirements and may fill Council needs in terms of geographic diversity, ethnic and cultural diversity, representation of rural and urban

areas, and so forth, will be invited to attend a group Interview Meeting with the Nominating

Committee in August. Those applicants selected by Nominating Committee and Council

will be submitted to the Governor.

3. Those individuals appointed by the Governor will be notified of their appointment by the governor’s office. Council asks the Governor’s office to make the appointments by October

1^st.

Submission of Application:

All materials are to be mailed to:

Nominating Committee
Ohio Developmental Disabilities Council
8 East Long Street, Suite 1200
Columbus , Ohio 43215

Applications cannot be considered unless all items in #I are received by

May 1, 2007. Please remind those persons writing letters of recommendation

of the deadline.

2007 APPLICATION FOR

GOVERNOR’S APPOINTMENT TO THE

OHIO DEVELOPMENTAL DISABILITIES COUNCIL

(PLEASE TYPE OR PRINT LEGIBLY)

NAME:

__________________________________________________________________________
First, Middle, and Last

LEGAL ADDRESS:

_____________________________________________

TELEPHONE:

HOME: ( )_______________ WORK: ( )_______________

CELL: ( ) ______________________

E-MAIL ADDRESS: ____________________________________

MARITAL STATUS: ___________________________________

CHILDREN: __________________________________________

DATE OF BIRTH: _____________________________________

PLACE OF BIRTH: ____________________________________

EDUCATION: (list degrees, major, school attended and year graduated)

____________________________________________________________________________

BUSINESS AND PROFESSIONAL EXPERIENCE: (list present job and most previous job, title, and dates worked)

____________________________________________________________________________

ORGANIZATIONAL MEMBERSHIPS: (list organizations, especially those in MR/DD field, role, or title and dates served)

____________________________________________________________________________

CIVIC ACTIVITIES:

____________________________________________________________________________

POLITICAL AFFILIATION: (necessary in order to document bipartisan membership)

____________________________________________________________________________

NOMINEE STATEMENT

I want to be considered for appointment to the Ohio Developmental Disabilities Council because:

____________________________________________________________________________

COUNCIL MEMBER REPRESENTATIVE CATEGORIES

Please consider me for a position as a (please check appropriate category below):

1. _____ Person with a developmental disability.

I meet this requirement because (please describe your developmental disability and when it began):

____________________________________________________________________________

2. _____ Parent or guardian of a child with a developmental disability.

I meet this requirement because my child has a developmental disability. Please state your relationship to the person with a developmental disability and describe his or her disability and when it began.

____________________________________________________________________________

3. _____ Immediate relative or guardian of an adult with a mentally impairing developmental disability who cannot advocate for himself/herself.

I meet this requirement because my relative has a mentally impairing developmental disability. Please state your relationship to the person with a mentally impairing developmental disability and describe his or her disability and when it began:

____________________________________________________________________________

4. _____ An immediate relative or guardian of an institutionalized or previously institutionalized individual with a developmental disability or an individual with a developmental disability who resides or previously resided in an institution. Please complete section a or section b.

_____ a. I meet this requirement because I am the immediate relative or guardian of an institutionalized individual with a developmental disability. Please explain: a) your relationship to the individual; b) his or her disability and when it began; c) whether the individual lives in an institution or previously lived in an institution, and d) the name of the institution.

____________________________________________________________________________

_____ b. I meet this requirement because I am an individual with a developmental disability who resides in or previously resided in an institution. Please explain: a) your disability and when it began; b) whether you live in an institution now or lived in one in the past; c) the names of the institution; and d) if you no longer live in an institution, how long ago you moved.

____________________________________________________________________________

5. _____ Representative from a county board of mental retardation and developmental disabilities.

Name of organization: ____________________________________________________________

____________________________________________________________________________

6. _____ Representative from a private agency serving persons with developmental disabilities.

Name and address of private agency: _______________________________________________

_____________________________________________________________________________

Types of services: __________________________________________________________

_____________________________________________________________________________

7. _____ Representative from a private nonprofit organization concerned with services for persons with developmental disabilities.

Name and address of organization: _________________________________________________

_____________________________________________________________________________

How is the organization concerned with services for persons with developmental disabilities?

_____________________________________________________________________________

NOTE: ONLY CATEGORIES 1, 2, AND 3 ARE OPEN THIS YEAR.

LETTERS OF RECOMMENDATION

Please submit two (2) letters of recommendation. List below the names of the two individuals who will be sending the letters.

1) __________________________________________________________________________

2) __________________________________________________________________________

RESUME

Please send resume or vita in addition to this application form.

---------------------------------------------------------------------------------------------------

Please return this application form [original and three (3) copies] and other requested material by May 1, 2007 to the following address:

Nominating Committee
Ohio Developmental Disabilities Council
8 East Long Street, 12th Floor
Columbus , Ohio 43215

EQUAL APPOINTMENT OPPORTUNITY INFORMATION

The Ohio Developmental Disabilities Council requests that you supply the information below in order to assist our efforts in regards to appointment. Your response is VOLUNTARY and will not in any way affect the processing of your application. This sheet will be processed separately and will not become part of your application. IT WILL BE USED FOR STATISTICAL PURPOSES ONLY.

NAME:

_______________________________________________________________________________
First, Middle, and Last

COUNTY OF RESIDENCE : ___________________________________________________________

DATE OF BIRTH: _________________________________________________________________
Month, Day and Year

RACE/ETHNIC GROUP:

_____ White
_____ Black
_____ Hispanic
_____ American
_____ Indian/Alaskan Native
_____ Asian/Pacific Islander

SEX

_____ Male
_____ Female

How did you find out about the vacancy(ies) you are applying for?

____________________________________________________________________________

OHIO DEVELOPMENTAL DISABILITIES COUNCIL

RESPONSIBILITIES OF MEMBERS

EXPECTED

1. Attend two (2) days of meetings, ten (10) times a year. Most of the meetings are in Columbus .

2. Attend Council’s Annual Conference and Legislative Event.

3. Participate in two (2) Committees of Council which meet during the regularly scheduled Council meetings.

4. Participate in new member Orientation sessions held during regularly scheduled Council meeting time.

5. Prepare for Council and Committee meetings by reading monthly information mailing.

6. Advocate for Council’s Mission and Philosophy.

7. Participate in the development of Council positions on matters of public policy.

8. Have the ability to communicate either by voice, interpreter, signing, augmentative communication device such as a Touch Talker or Word Board.

9. Participate in at least one (1) grant review panel for the purpose of awarding DD Council funds.

10. Read and respond to action alerts.

11. Consult with Council staff as needed.

VOLUNTARY

1. Serve on various Council ad hoc groups.

2. Represent Council at selected state or local events.

3. Assume role of Committee Chair, if elected.

4. Mentor a new Council Member.

5. Provide information to legislators, federal and state.

6. Share information between council and other organization, as appropriate.

7. Serve on groups external to Council.

8. Participate in visits to Council projects with Council staff.

This page must be signed and returned with your application.

1. Read the separate application form of the Governor’s. It is the form titled “Ted Strickland, Governor, State of Ohio , Department of boards and Commissions Questionnaire.”

2. Decide if you will be able to complete this form if Council decides to

recommend to Governor Strickland that you be appointed. If the DD Council selects you for an opening, you will be required to complete the Governor’s form in September.

4. Do not fill out the Governor’s form now. The Governor’s office will want it to be dated and notarized in the fall.

I have reviewed Governor Strickland’s form. If the DD Council decides to submit my name to the Governor for appointment, I will fill it out, sign it and have it signed by a Notary Public at that time. I do not have any concerns that will keep me from signing it.