top of page
Disability Rights of West Virginia
Board of Director’s Biographical Data Sheet
DRWV is committed to diversity, integration, and equity in all of DRWV’s work and the different perspectives of all West Virginians
How do you prefer to receive mail?
How do you prefer to receive calls?
Primary Interest

For Federal grant documentation and report purposes, please check all that apply:

Gender
Ethnicity
Are you a person with a disability?
If so, what is/are your disability(ies)? (Please check all that apply)
Are you a guardian of a person with a disability?
If so, what is/are their disability(ies)? (Please check all that apply)
If the person for who you are a guardian is eligible for services, what age is that person who is eligible? Check all that apply
Do you have a family member who has a disability?
If so, what is/are the family member's disability(ies)? (Please check all that apply)
If your family member is eligible for services, what age is that person who is eligible? (Check all that apply)
Are you a professional in the field of… (Please check all that apply)
Are you a service provider for persons with… (Please check all that apply)
Are you an advocate for persons with… (Please check all that apply)
Are you an Attorney?
Are you an individual from the public knowledgeable about… (Please check all that apply)
Are you a person who broadly represents or is broadly knowledgeable about the needs of people with… (Please check all that apply)
Are you a Board Member or Advisory Council Member for a provider of services to Individuals with Disabilities?

Thank you for applying! We'll get back to you soon.

bottom of page