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Organizational Membership Application

Organization Information

Organization Name *

Primary Contact First Name *

Primary Contact Last Name *

Title *

Phone *

Email *

Website *

Address

Street Address

City

State

Country

Postal code

Organizational Structure & Scope

If Other, please explain

Is your organization led by or meaningfully guided by people with disabilities? *

If Yes, please explain

Geographical Area Served in Arizona *

Mission Alignment

DAPA Mission: To unify and mobilize an Informed disability community in Arizona that

advocates for policies and legislation that positively impacts their lives.

DAPA Vision: An Arizona that respects and appreciates all individuals with disabilities,

creating systems that recognize their fundamental human rights and embrace their

contributions to society.

Describe your organization's mission and programs: *

How does your work align with DAPA's mission, vision, and values? *

Which of DAPA’s strategic focus areas align with your work? Check all that apply. *

Training: Equip Arizona's disability community and caregivers to participate in the legislative process. Including: a. Use of the Request to Speak (RTS) system. b. Preparing and delivering testimonials at committee hearings.

Tracking: Monitor legislation and policy changes, understand the ramifications of policies/legislation on the disability community, develop position statements and media releases, build consensus and create "calls to action" to mobilize advocates.

Teaching: Build relationships with and educate Arizona policymakers about. the needs and priorities of the disability community.

Advocacy & Collaboration

Describe your advocacy or systems change work: *

Are you willing to share advocacy alerts, events, or trainings? *

Do you commit to respectful, inclusive collaboration? *

Agreement to DAPA's Guiding Principles

By checking each box, on behalf of my organization, we agree to DAPA's Guiding Principles: *

We support DAPA’s mission to be a unified, cross-disability voice advancing advocacy, rights, and justice across Arizona.

We share DAPA’s vision of an inclusive and equitable Arizona where all people with disabilities are valued, heard, and empowered to shape policy and community life.

We uphold and actively promote DAPA’s core values: Equity & Justice, Disability-Led Advocacy, Transparency & Accountability, Collaboration & Shared Power, Accessibility & Inclusion, Community Engagement, Nonpartisan Policy Work.

We support DAPA’s strategic goals: policy/systems change, leadership development, access to information, civic engagement, transparency.

We agree to participate in DAPA in good faith with equity and inclusive collaboration.

We will maintain a nonpartisan approach to advocacy while working through the alliance.

Authorized Organization Representative Signature *

Clear

Draw Your Signature in the Box Above

Authorized Organization Representative Typed Full Name *

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