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Board Member Application

Thank you for your interest in DRP and the Mental Health Advisory Council (MHAC), and for taking the time to submit an application for membership.

All applications are reviewed by the joint DRP Board/MHAC Nominating Committee for membership eligibility.  The Nominating Committee takes into account the current composition of the DRP Board and the MHAC, along with anticipated needs for new members.  If the Nominating Committee determines that you are a good fit for the Board or MHAC, you will be contacted for an interview.  Please note that not all persons who submit an application for membership are interviewed but you will be contacted either way.

MISSION STATEMENT:  Disability Rights Pennsylvania protects and advocates for rights of people with disabilities so that they may live the lives they choose, free from abuse, neglect, discrimination, and segregation.

VISION STATEMENT:  A Commonwealth where people of all abilities are equal and free.

Download Application to become a DRP Board Member

Download Application in Word

Please return your completed application and any additional documents (e.g. your resume) to:

Samyra Bethune, Administrative Assistant
Disability Rights Pennsylvania
301 Chestnut Street, Suite 300
Harrisburg, PA 17101

You can also fax your application materials to Samyra at 717-236-0192 or email it to Samyra at:


Apply Online to become a DRP Board Member

  • This application can be used to apply for the DRP Board of Directors, the Mental Health Advisory Council or both. Please indicate which membership you are applying for by checking one of the boxes above.
  • Personal Information
  • Information to Help us Know You
    You can attach additional pages when completing this section. If you have a resume, please provide it when you submit your application.
  • Additional Personal Information
    The information below is collected for federal reporting purposes. We also request this information, along with the demographic information in Section I., to assure a diverse and effective board and MHAC membership, and because Federal law (P.L. 99-319) requires the MHAC to include the following representation. Please check all that apply. Your assistance in providing the information is voluntary.
  • DRP does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status in any of its activities or operations. These activities include, but are not limited to, hiring and firing of staff, selection of volunteers and vendors, and provision of services. DRP is committed to providing an inclusive and welcoming environment for all members of its staff, volunteers, subcontractors, vendors, and clients.
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    Accepted file types: doc, docx, pdf, Max. file size: 20 MB, Max. files: 2.
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