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PAIMI Application

Please complete this online form to apply to become a member of the Disability Rights Ohio PAIMI Advisory Council. Please do not include any personally identifying information in your answers, for example your Social Security number or date of birth.

In addition to this online form, please also submit two letters of reference/recommendation from persons of your choice to the Ohio PAIMI Advisory Council, c/o Disability Rights Ohio, 200 Civic Center Drive, Columbus, OH 43215-4234 or fax them to 614-644-1888.

* indicates required information

* If necessary, would you be able to travel to be interviewed at a PAIMI Council meeting? Travel expenses will be reimbursed, but we encourage you to notify Disability Rights Ohio if pre-paying your expenses is a barrier to your participation.

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