Apply to Become an OLRS PAIMI Advisory Council Member

If you are interested in becoming a member of the OLRS PAIMI Advisory Council, you will need to complete an application form. Choose from one of the following ways to send us your application form.

• How to Complete an On-line Application Form
• How to Download a Printable Version of the Application Form

How to Complete an On-line Application Form

Use the form below to complete an application for consideration to be a member of the Ohio PAIMI Advisory Council. Once you have completed the application, click the "Submit" button at the bottom of the application form. The application will be automatically emailed to OLRS. In addition to completing this on-line application, please submit two letters of reference/recommendation from persons of your choice. These letters can be mailed or faxed to:

Ohio PAIMI Advisory Council
Ohio Legal Rights Service
50 West Broad Street, Suite 1400
Columbus, Ohio 43215-5923
Fax: 614-644-1888

If you have questions, call OLRS at 614-466-7264 or 1-800-282-9181; TTY 614-728-2553 or 1-800-858-3542.

Name:       Address:       City, State, Zip Code:       Home and Business Telephone:       Cell Phone:       E-mail address:       List practical and/or personal experience with the mental health system.         List present employment and last employment. Include volunteer positions as employment.         List organizational memberships and/or associations especially those in the mental health field.         List education and training, both formal and informal in the mental health, legal, and advocacy areas.         The Federal PAIMI Act mandate requires that the PAIMI Advisory Council consist of individuals representing different constituency groups. These eight categories are listed below within the next two questions.     Choose all the categories that you are qualified to represent.     Attorney     Mental health professional     Provider of mental health services     Individual who has received or is receiving services     Family member     Knowledgeable individual about people who are labeled mentally ill     Person under the age of 21 who has received or is receiving services     Parent of a minor child who has received or is receiving services     From the categories you chose above, choose the ONE category that you are BEST qualified to represent.     Attorney     Mental health professional     Provider of mental health services     Individual who has received or is receiving services     Family member     Knowledgeable individual about people who are labeled mentally ill     Person under the age of 21 who has received or is receiving services     Parent of a minor child who has received or is receiving services.     The nominating committee, composed of Advisory Council members, meets several times a year to review applications. During the process of selection the nominating committee may invite you to be interviewed by the committee. OLRS will reimburse potential council members for travel expenses. Do you have any objections?     No     Yes (please describe objection)          Provide a Nominee Statement I want to be considered for appointment to the Ohio PAIMI Advisory Council because:         In addition to completing this on-line form, please submit two letters of reference/recommendation from persons of your choice. These letters can be mailed to: Ohio PAIMI Advisory Council Ohio Legal Rights Service 50 W. Broad St., Suite 1400 Columbus, OH 43215-5923 Phone: 614-466-7264 or 1-800-282-9181 TTY: 614-728-2553 or 1-800-858-3542 Fax: 614-644-1888

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How to Download a Printable Version of the Application Form

If you prefer to mail or fax your application form to us, do the following.

1. Download the Application for the OLRS PAIMI Advisory Council (PDF file). (Note: To download an application, you need to have Adobe® Reader®, a free software program, installed on your computer. Download Adobe® Reader®)
2. After downloading, print the form.
3. Complete the form and mail it to OLRS (the address is found on the application form) or fax it to 614-644-1888.

If you have questions, call OLRS at 614-466-7264 or 1-800-282-9181; TTY 614-728-2553 or 1-800-858-3542.

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