Arkansas Brain Injury Council Membership Application

The Arkansas Brain Injury Council (ABIC) provides advice and expertise to create and strengthen a system of services and supports that maximizes the independence, well-being, and health of people with brain injuries through the development and monitoring of a Colorado Brain Injury State Plan. Please visit and read about the current goals and strategies in the current Arkansas State Plan 2018-2021.

The Council consists of 21 members.
The Council is made up of people who have lived brain injury experience, family members or caregivers, and representatives from organizations and agencies that serve and support the brain injury community.
Full Council meetings are held quarterly with committee meetings in between as needed.
When in-person meetings are held, reimbursement of travel costs are available (per the State of Arkansas’ travel reimbursement policies).
Terms are four years in length and start in the month of July, unless filling a vacated seat.

If you are interested in serving as an ABIC member, please complete this form. There is not a deadline to apply. The team will keep all applications on file for future Council openings. If you have questions or problems with the form, please email braininjury@uams.edu.

Application

Your Personal Information

Your Name(Required)

First Last

Organization (if applicable)

Title (if applicable)

Your Email Address(Required)

Enter Email Confirm Email

Phone Number(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Are you:(Required)

A person with lived experience – traumatic brain injury

A person with lived experience – non-traumatic brain injury (e.g. stroke, anoxia, etc.)

A family member or care giver of a person with a brain injury

A member of an organization that serves people with brain injury

Application Questions

The Advisory Board meets four times each year and terms are four years in length. Can you commit to meeting quarterly for the next four years?(Required)

Yes

Please tell us how you learned about the Arkansas Brain Injury Council (ABIC). Did someone refer you?(Required)

What interests you in applying to be a member of the ABIC?(Required)

As a member or ally of the brain injury community, you know that people with brain injuries and their families face many challenges. What do you think are the most pressing problems in this community?(Required)

Tips for answering this question: 1) Start by brainstorming a list of possible challenges. 2) Pick 2 or 3 and think about how these challenges have affected people in your community (or yourself if you have experienced a brain injury). 3) Be specific and provide examples. 4) Explain why you believe these challenges are the most pressing.

We would love to learn more about your involvement and advocacy experiences with other organizations, boards, or groups. Please share any relevant information regarding your engagement in other entities and your contributions to their initiatives or causes.(Required)

At our organization, we prioritize health equity, cultural competency, understanding health disparities, and fostering overall inclusion. We are interested in hearing about your experiences in learning about and advocating for equity, diversity, and inclusion. We invite you to share your involvement in these areas and the initiatives you have undertaken to promote them. Additionally, please let us know specific areas of interest where you would like to expand your knowledge and understanding, as we aim to support continuous learning and growth in these crucial domains.(Required)

Please provide us with the names and contact information of two people we can contact who would recommend you for the ABIC:(Required)

Contact # 1

Name

Relationship

Phone

Contact # 2

Name

Relationship

Phone