Careers PAIMI Member Position Status: Open Read More DRAZ PAIMI Advisory Council Questions for Prospective Members Step 1 of 3 33% Name(Required) First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneFaxEmail 1. Why are you interested in serving on the DRAZ PAIMI (Mental Health) Advisory Council?2. What is your experience with mental health issues in the State of Arizona?3. Can you make the commitment to attend up to four meetings per year (in person or by conference call)?4. What other skills or experience would you bring to the Council? For DRAZ federal reporting purposes:Are you a person who had/or is receiving mental health services? Yes No Do you have a family member who had/or is receiving mental health services? Yes No Are you employed in a field related to mental health issues? Yes No What is your occupation? (Select all that apply) Mental health service provider Social worker Psychologist Psychiatrist Psychiatric Nurse Practitioner Psychiatric Nurse Peer Support Specialist Attorney Other (please describe) Occupation (other)Do you identify yourself as a member of one of the following ethnic/racial groups? African-American Asian Native American Hispanic Caucasian Other (please describe) Identity (other) Pages: Page 1, Page 2
