2. TOWN OF SAN ANSELMO
   
4. APPLICATION FOR APPOINTMENT TO A SAN ANSELMO BOARD/COMMISSION/COMMITTEE
6. 
   To: San Anselmo Town Council
8. Date*
10. I wish to apply for an
    appointment to a term/balance*
    -- Select One --SelectArts CommissionBicycle and Pedestrian CommitteeBoard of ReviewClimate Action Commission Economic Development CommitteeFlood CommitteeHistorical CommissionInfrastructure and Fiscal Monitoring CommitteeLibrary Advisory BoardLibrary Parcel Tax Oversight CommitteeMarin Commission on AgingMarin Sonoma Mosquito Abatement & Vector DistrictOpen Space CommitteeParks & Recreation CommissionPlanning CommissionRacial Equity CommitteeRedhill Dog Park Steering CommitteeRobson-Harrington Community Garden Steering CommitteeRoss Valley Paramedic AuthoritySkate Park Steering CommitteeTax Equity Board
12. Name*
14. Home Address*
16. Occupation*
18. Employer's Address
20. Home Phone*
22. Work Phone
24. Cell Phone
26. E-Mail*
28. Number of years as resident of San Anselmo*
30. Number of years as a resident in Marin*
32. Education Level Achieved*
    -- Select One --SelectGraduate Degree (Major)College/University Degree (Major)Some CollegeHigh School DiplomaOther (Explain)
34. Name and phone numbers of three San Anselmo residents who can be contacted for referral information about me:
36. 1.) Name*
37. 1.) Phone*
39. 2.) Name*
40. 2.) Phone*
42. 3.) Name*
43. 3.) Phone*
45. I would be able to regularly attend the meetings of this Board/Commission/Committee.*

    1. YES
    2. NO
47. I would be available to attend additional meetings when they are necessary.*

    1. YES
    2. NO
49. I am familiar with the responsibilities and functions of this Board/Commission/Committee.*

    1. YES
    2. NO
51. I have attended meetings of the Board/Commission/Committee as a member of the public.*

    1. YES
    2. NO
53. List briefly, previous experience serving the public office, and/or civic commissions,boards, or committees.*
55. Reasons for this appointment.*
57. What are your qualifications for this appointment.*
59. Briefly, what do you consider to be the most important, one or two current issues facing this Board/Commission/Committee?*
61. I understand that I and all other applicants will be personally interviewed by the Town Council as part of the selection process for this appointment. I also understand that my application material will be a public document and available on the Town's website. Sensitive materials that you don't wish to be posted on the website should not be included with the application.*

    1. YES
    2. NO
63. Other Boards/Commissions/Committees on which you would be interested in serving if not appointed to this seat?*
    -- Select One --SelectNoneArts CommissionBicycle and Pedestrian Advisory CommitteeBoard of ReviewClimate Action CommissionEconomic Development CommitteeFlood CommitteeHistorical CommissionInfrastructure and Fiscal Monitoring CommitteeLibrary Advisory BoardLibrary Parcel Tax Oversight CommitteeOpen Space CommitteeParks & Recreation CommissionPlanning CommissionRacial Equity CommitteeRed Hill Dog Park Steering CommitteeSkate Park Steering CommitteeRobson-Harrington Community Garden Steering CommitteeTax Equity Board
65. You may attach personal resumes or other information which you believe would be helpful to the Council in its selection process.
67. Thank you for your interest in serving the Town of San Anselmo and its citizens. For further information, please contact the Town Clerk, at townclerk@townofsananselmo.org or 415-258-4660.
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