Palestinian Smart Parliament Persons with Disabilities and Community Integration Unit Membership Application Form

Official Application

Smart Palestinian Parliament Unit for Persons with Disabilities and Community Integration Membership Application Form

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3Gender*

MentionedFemale

4Place of residence*

7Academic qualification*

9Work entity / institution

11Do you have a disability?*

YesNo

12If the answer is yes, what type of disability?

13Have you ever worked in a center or institution that cares for people with disabilities?*

YesNo

14If the answer is yes, name of the institution / center

15If the answer is yes, the duration of work

16If the answer is yes, the job title

17Do you have knowledge of institutions or centers that care for people with disabilities?*

YesNo

18If the answer is yes, please mention the names of the institutions/centers if possible.

19Do you have experience or knowledge in any fields related to disability and community integration?*

20If you chose "Other," please specify.

21Number of years of experience or involvement in the field of persons with disabilities and community integration

22Highlight the experiences or activities you have participated in the field of disability and community integration.

23Why would you like to join the Disability and Community Inclusion Unit?*

24What area would you like to contribute to within the Unit for Persons with Disabilities and Community Integration?*

25If you chose "Other," please specify.

26What initiative or idea do you propose to serve people with disabilities and promote community integration?

27What motivates you to join the Unit for Persons with Disabilities and Community Integration?*

28Can you participate in the activities and events of the unit?*

Yes, regularly.As per the possibilityRemote

29Are you willing to participate in work teams and committees?*

YesNo

30Do you have experience in volunteer or community work, especially in the field of disability?*

YesNo

31If the answer is yes, please explain your experience in volunteer or community work.

32Please select the skills you possess.*

33If you chose "Other," please specify.

Section 5: Official Acknowledgment & Commitment

* Mandatory Acknowledgment

I declare that the information provided in this form is true and accurate, and I pledge to abide by the regulations and instructions of the Palestinian Smart Youth Parliament, maintain confidentiality and privacy, respect professional ethics in mental health and psychosocial support, and not use the name of the unit or parliament in any activity without official authorization.

Smart Palestinian Youth Parliament

Section 5: Official Acknowledgment & Commitment