Thank you for your interest in an appointment to the FCC’s Disability Advisory Committee.

All applicants are urged to carefully read information about this membership solicitation and application instructions available in Word or PDF format. Note: Your request for membership will not be complete until submission of this form, submission of your resume, and any other supporting documents requesting.

For organizational applicants only

(Use this section if you are applying as the representative of an organizational applicant.)

Organizational applicant’s primary representative:

Example: 555-555-5555

Organizational applicant’s alternate representative:

Example: 555-555-5555

Nomination of representative(s):

The Commission’s ethics counsel requires that the above applicant(s) be officially nominated by your organization from a person with authority. This nomination will affirm that the nominee(s) are authorized to represent your organization at the DAC. You may be a person of authority in your organization, but it may be wise to have the nomination submitted by a second person with authority in your organization. A person with authority is someone with the authority to appoint representatives on behalf of the organization.

Please enter the email address and title of a person with authority to nominate the applicant(s) . They will receive instructions on how to complete the nomination.

For individual applicants only

(Use this section if you are applying in your individual capacity and are not a representative of an organizational applicant.)

Example: 555-555-5555

NOTE: Those serving in an individual capacity and not as a representative of an organizational applicant may not be federally registered lobbyists and must also file confidential employee financial disclosure forms prior to beginning their service and annually thereafter.

For all applicants

(All applicants please complete this section.)

This narrative is limited to 3500 characters. You have 3500 characters remaining.

Applications will be received until 11:59 EST, August 13, 2020.

As noted in the public notice in Word or PDF, announcing this solicitation, applications are subject to the renewal of the Committee’s charter and all Committee members are subject to an ethics review prior to service.

Any questions, please contact Debra Patkin, Designated Federal Officer (DFO) of the Committee, Phone/Videophone for American Sign Language users: 202-870-5226; Email: Debra.Patkin@fcc.gov or Will Schell, Deputy DFO of the Committee, Phone: 202-418-0767 (voice or relay); Email: Will.Schell@fcc.gov.

In addition to the information provided in the online application, please complete your application as follows:

If you are applying in your individual capacity, please upload a copy of your resume on the next page.

If you are an organizational applicant, please upload a copy of both the primary and alternate representative’s resume on the next page.