YOUTH COMMISSIONER APPLICATION - 2018/19

Please select which Committee you are applying for:

Arts Commission Bicycle and Pedestrian Advisory Committee Historical Commission Library Advisory Board

Open Space Committee Parks & Recreation Committee Quality of Life Commission

If you are applying for more than one Committee please list in order of preference.

Date:*

Phone:*

Email:*

Name:*

Home Address:*

Grade in Fall 2018:*

School:*

Current GPA:*

Parent or Guardian:*

Please list any organized activities that you have participated in:

Activity/Sport

Year

Coach/Teacher

Activity/Sport

Year

Coach/Teacher

Please tell us why you wish to apply for this appointment:*

Please tell us how you think you can help the Commission/Committee improve:*

Please tell us what you think are the most important issues facing the Commission/Committee:*

Name and phone numbers of three San Anselmo residents who can be contacted for referral information:

1.) Name*

Phone*

2.) Name*

Phone*

3.) Name*

Phone*

I would be able to attend monthly meetings of this Commission:*

YES

NO

I would be able to serve for a period of one year:*

Yes

No

I am familiar with the responsibilities & functions of this Commission:*

YES

NO

You may attach personal documents that you believe will be helpful to the Commission/Committee in making its selction process:

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Thank you for your interest in serving the Town of San Anselmo and its citizens. For further information, please contact the Town Clerk, Serge Avila, at 415-258-4660 or savila@townofsananselmo.org.

Application must be returned to Town Hall no later than April 26, 2018