PWD would like to tap into the knowledge and skills of its members by involving you in expressing the views of people with disabilities to government and service providers. There are many ways in which you could participate. If you would like to become involved in PWD’s work, please complete the attached form. We will contact you when suitable opportunities become available.
Name:
Address:
Email:
Telephone:
Age:
Please list any consumer groups you belong to (e.g. People with Disabilities ACT, Blind Citizen’s Australia, Mental Health Consumer Network):
Have you represented consumers on any previous committees or forums? If so, please provide details:
Would you like to:
Represent people with disabilities on a committee
Be part of a focus group
Comment on proposals from time to time
Participate in consultations
Please tell us which topics would interest you:
Health issues
Health services
Respite
Community attitudes
Transport
Access to buildings
Access to services
Mobility aids
Housing
Leisure
Communications
Other – please provide details:
Please use this space to tell us about any support needs you have (e.g. carer, wheelchair parking, etc):
Sometimes PWD needs to identify consumer representatives with particular personal experiences of disability (such as a sight impairment or an intellectual disability) to comment on specific issues or services relevant to this group. If you are happy to be identified in this way, please provide some details on your disability below:
Physical
Sight impaired
Intellectual disability
Psychiatric disability
Deaf or hearing loss
Acquired brain injury
Other (please specify):
If you are in paid employment or voluntary work, please tell us who you work for:
How much time does this take each week?
Thank you. Please click the button below to add your responses to our consumer skills database. We will contact you when there is an opportunity for you to be involved.
With assistance from the ACT Government under the Disability ACT Innovation Program.
People With Disabilities ACT Inc.Phone 6290 1984pwdact@shout.org.au
Maintained by Focus Web Design