Stone County Developmental Disability Board

Stone County, Missouri

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Become a Board Member

Download the Board Application Here!

Or fill out the form below and print it and mail it to our offices.

Board Member Application

Name*
Date*
Address
City*
State*
Zip Code*
Home Telephone Number*
Work Telephone Number
Work E-Mail
Personal E-Mail*
Occupations - Title and Description*
Business Street Address
City
State
Zip Code
Other Affiliations/Board Service
Do you have a family member with a Developmental Disability?
- Yes
- No
If so, what is your relationship?
Why are you seeking appointment to the Stone County Developmental Disability Board?
Give a brief description of your education, experiences, and/or any other special skills or qualities that will help the Commission in its selection of Stone County SB40 Board members.
I have been made aware of the responsibilities of members of the Stone County Developmental Disability Board, and am willing to make a commitment to the Board as a member.
Signature*
Date*
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