PAIMI Council Application - Advocacy Center

PAIMI (Protection and Advocacy for Individuals with Mental Illness) Council

All information, aside from email, is optional. All information will remain confidential.
Comments
If you are interested in finding more about the PAIMI Council, please complete the information below.
Full Name
Street Address
Home Phone
Work Phone
Mobile Phone
Mandatory field Email*
Ethnicity
Please answer yes or no to as many of the following yes/no questions as apply to you. Are you:
Recipient / Former Recipient of mental health services
If you answered yes, please describe disability. (All information will remain confidential.)
Parent / Family Member of someone whom receives mental health services
If you answered yes, please describe disability. (All information will remain confidential.)
Mental Health Service Provider
Mental Health Professional
an attorney
Individual from the public knowledgeable about mental ilness
Why are you interested in becoming a member of the PAIMI Advisory Council?
Please list the reason(s) mental health issues are important to you.

Advocacy Center
8325 Oak Street
New Orleans, LA 70118

1.800.960.7705
(Voice or call relay at 711)

1.855.861.3577 (TTY)

advocacycenter@advocacyla.org

For information in Spanish please call 1-800-960-7705, press 3. Para información en español por favor llame 1-800-960-7705, oprima 3.

For information in Vietnamese please call 1-800-960-7705, press 4. Để đòi hỏi những công tác (dịch vụ) bàng tiếng Việt, xin gọi 1-800-960-7705, mở rộng 4.

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