RICAT Application for Membership

If you would like to be considered as a member of RICAT,
please complete the following information:

IDENTIFICATION DATA

Home Phone:

Cell Phone:

EDUCATION

EMPLOYMENT (Two most recent employers)


BUSINESS AND PROFESSIONAL ORGANIZATIONS (Include Business Directorships)



CIVIC, CHARITABLE, OTHER ORGANIZATIONS
(Please list current or recent affiliations)



What do you feel are your strongest areas of expertise based on your background experiences?

 

Other (specify):

 

Indiciate primary areas of interest outside your area of expertise:

Other (specify):

 

The following information is optional:

Age: 20-35 36-50 51-65 Over 65

Ethnicity: Black White Asian Native American Hispanic
Other (specify):


(For example, interpreters, ASL, or language (please specify):

If you have any questions regarding the application process, please contact Rebecca Cloutier at 401.462.7914.

 

 


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This project was supported, in part, by grant #1601RISGAT, from the US Administration for Community Living, Department of Health & Human Services, Washington, DC 20201.
Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.
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Last updated: April 1, 2016