Skip Navigation >>

Advancing the Human & Civil Rights of People with Disabilities in Illinois

Menu

TBI Advisory Council Application

    Contact Information (* Required)

    *First Name

    *Last Name

    Title

    *Street Address

    *City

    *State

    *Zip Code

    *Email Address

    *Confirm Email Address

    *Telephone Numbers
    Home:

    Cell:

    Work:

    Current Place of Employment

    Briefly describe your experience or expertise with traumatic brain injury issues:

    How did you learn of our Traumatic Brain Injury Advisory Council?

    Why do you wish to join our Traumatic Brain Injury Advisory Council?

    Additional Comments

    Check here to verify you are human. (required)

    |  Print

    Last updated: May 15, 2018

    This website is made possible by funding support from the U.S. Department of Health and Human Services, both the Administration on Developmental Disabilities and the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration; and the U.S. Department of Education, the Office of Special Education and Rehabilitative Services. The contents of this website are solely the responsibility of Equip for Equality and do not necessarily represent the official view of any of these agencies.

    Designed & Developed by Firefly Partners