1

Please provide your contact information.

 *

Please provide your contact information.

Salutation (Mr. Ms. Mrs.)	First Name*	Last Name*
Address*	Zip Code*	E-mail Address*
Home Telephoneext.	Business Telephoneext.	Cellular Telephoneext.

2

Which Neighborhood Council do you reside in? 

 

Which Neighborhood Council do you reside in?

NC #1

NC #2

NC #3

NC #4

3

Please provide your employment information.

Please provide your employment information.

Place of Employment

Job Title

Usual Duties

4

How did you hear of the Neighborhood Councils?

How did you hear of the Neighborhood Councils?

City's Website	Friend/Neighbor
Served Previously	Current/Past Executive Board Member
Nixle	Television
Newspaper	Email from City
Other If other, type text here.

5

Please list other community activities in which you are involved.

Please list other community activities in which you are involved.

6

Please check the areas you are interested in.

Please check the areas you are interested in.

Community Planning	Emergency Preparedness/Public Safety
Community Programs	Government in General
Environmental Issues	Social Services
Other If other, type text here.

7

Although it is not required, it is strongly recommended that applicants attend at least two Neighborhood Council meetings prior to appointment. How many Neighborhood Council meetings have you attended?

Although it is not required, it is strongly recommended that applicants attend at least two Neighborhood Council meetings prior to appointment. How many Neighborhood Council meetings have you attended?

8

Why are you interested in serving as an Executive Board member?

Why are you interested in serving as an Executive Board member?

9

What do you see as your responsibilities if appointed as a Neighborhood Council Executive Board member?

What do you see as your responsibilities if appointed as a Neighborhood Council Executive Board member?

10

Why do you think the Neighborhood Councils are important?

Why do you think the Neighborhood Councils are important?

11

Are you willing and able to attend monthly Neighborhood Council meetings and perform other duties such as flyer distribution and volunteering at Neighborhood Council sponsored activities?

 *

Are you willing and able to attend monthly Neighborhood Council meetings and perform other duties such as flyer distribution and volunteering at Neighborhood Council sponsored activities?

Yes

No

12

Have you previously served as an Executive Board member?

 *

Have you previously served as an Executive Board member?

Yes (Indicate dates served) If other, type text here.

No

13

Please add any additional information you would like considered.

Please add any additional information you would like considered.

14

By checking the box and entering my name below, I am submitting my application to serve as a Neighborhood Council Executive Board member.

Applicant Signature* If other, type text here.

Thank you for your interest in serving as a Neighborhood Council Executive Board member. If you have any questions or concerns, please contact the Community Services Coordinator at (805) 583-6756.

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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