DD-PIT Application Return Home Click for a printable application Developmental Disabilities Practice Improvement Team (DD-PIT) Application Name* First Last City*County*Phone*Email* Organization (If applicable)Position within organization (If applicable)Are you 18 years or older?* Yes No Do you identify as a person with an intellectual or developmental disability?* Yes No Do you currently receive services from a CMHSP? Yes No Have you ever received services? Yes No When is the last year?Application Over, Please ExitDo you use self-directed services (self-determination)? Yes No Which category are you applying to fill?*Click below to select positionAdult with Intellectual/ Developmental DisabilitiesParent or Family Member of Youth with Intellectual/Developmental DisabilitiesPre-Paid Inpatient Health (PIHP) RepresentativePre-Paid Inpatient Health (PIHP) or Community Mental Health Provider (CMHSP) Administrator (Utilization Management, Finance, or similar role)Representative of Independent Facilitators, Supports Brokers, or Independent Supports CoordinatorsWhy would you like to join the DD-PIT?*Please describe relevant experience and/or expertise, that would make you a valuable and contributing member of the DD-PIT. Share your experience with person-centered planning, self-determination, and family and youth guided principles.*Do you commit to uphold the Mission and Vision of the DD-PIT?* Yes No Do you have access to a laptop, tablet, or smartphone to attend virtual meetings?* Yes No Do you need support to use a laptop, tablet or smartphone to attend virtual meetings?* Yes No Do you have wi-fi access (internet service)?* Yes No Do you need any accommodations to fully participate in DD-PIT virtual meetings?* Yes No Please describe the accommodation you need to virtually participate in DD-PIT meetings.NameThis field is for validation purposes and should be left unchanged.
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