1132 Bishop Street, Suite 2102, Honolulu, Hawaii 96813
Phone (v/tty) - (808) 949-2922Statewide Toll-Free(v/tty) - 1-800-882-1057Fax - (808) 949-2928
E-mail - info@hawaiidisabilityrights.org Website -www.hawaiidisabilityrights.org


1. Name
2. Home Address
3. Telephones Home Business Fax Cellular
4. E-mail Address
5. Willing to serve a 3-year term? YES NO
6. Willing to attend most or all of the monthly meetings, 1st Friday, 12 noon? YES NO
7. Willing to serve on a committee of the Board? YES NO
8. Willing to serve as an officer of the Board? YES NO
9. Willing to sign the HDRC Code of Ethics? YES NO

10. HDRC protects and advances the human, civil and legal rights of people with disabilities. Will you fully embrace and support the mission of HDRC?
11. People with disabilities are the constituents of HDRC. Please describe your ability to represent this constituency on the Board of Directors.
12. The Board of Directors should be broadly representative of the community and reflect the disability, ethnic and geographic diversity in Hawaii's people. How will you enhance the diversity of the HDRC Board of Directors?
13. HDRC members are the governors of the non-profit corporation, with a wide range of fiduciary responsibilities. Describe the skills and expertise you will bring to the governing capacity of the board.
14. HDRC board members must avoid actual or potential conflicts of interest. Please list current community volunteer activities, including board and council memberships.
15. Federal law requires that the majority of HDRC members belong to one of the following groups. Please indicate which group(s) you belong to:
  • Person with a disability
  • Parent or family member of a person with a disability
  • Guardian, advocate or authorized representative of a person(s) with a disability
  • If none of the above, please specify:
  • Signature Date