Subdivision Support Committee Member Application

Subdivision Support Committee
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Organization or Institutional Affiliation*
DEC Membership

You must be a CEC/DEC member during the length of your term is selected for the committee. You can join or check on your current membership at exceptionalchildren.org/account
Are you a current DEC member?*

YesNo
Title/Role: (Select your current primary role)*

Administrator/CoordinatorAdvocateAssociation LeaderBehavior Specialist/Mental HealthChild Care ProviderConsultant/Trainer/TA ProviderEarly Childhood EducatorEarly Childhood Special Education TeacherEarly Intervention PractitionerElementary Special Education Teacher (5+)Family MemberHead Start/Early Head Start ProviderHealth Care Provider/Public Health ProfessionalHigher Education FacultyOccupational TherapistParaprofessionalPhysical TherapistPolicymakerPsychologist/School PsychologistResearcherService CoordinatorSocial WorkerSpeech and Language TherapistState Administrator/StaffStudentOther
If you did not select family member above, are you also a family member of a young child with a disability?*

YesNo
Demographics (Optional)
Gender
Race/Ethnicity
Ability/Disability
Please describe your interest in subdivision support.*
Describe your experience with and commitment to racial equity and its intersectionality with other forms of oppression (e.g., ableism, classism, sexism)? (See DEC’s Racial Equity Audit and DEC’s Racial Equity Point of View* for more information related to DEC’s position on racial equity).*
*Access the Racial Equity Audit here and the Racial Equity Point of View here.
Are you willing to serve a two-year term with opportunity for a two-year reappointment?*

Yes
Are you willing to attend and contribute to monthly committee conference calls as well as the bi-monthly subdivision leader meetings?*

Yes
Are you willing to make the necessary time commitment (approximately 5-10 hours per month spent with activities such as planning and conducting subdivision meetings as well as individual technical assistance to subdivisions).*

Yes
Should be Empty: