The URL can be used to link to this page

00-516ORIGINAL Council File # 00� S l� creen sheet # IctSqSq RESOLUTION CITY OF SAINT PAUL,IVIINNESOTA Presented By Referred To Committee: Date � i 2 3 4 5 6 � a 9 io ii iz 13 14 RESOLVED, that the Saint Paul City Council consents to and approves of the appointment and reappointment, made by the Mayor, of the following individuals to serve on the CITY OF SAINT PAUL CIVIL SERVICE COMMISSION. APPOINTMENT REAPPOINTMENT Sherri Mortenson-Brown Nancy Dudley Kelly Sherri Mortenson-Brown shall serve the remainder of Harry Gastons' unexpired term. This term shall expire on June 13, 2002. Nancy Dudiey Kelly shall serve a six-year term which will expire on June 13, 2006. 15 Requested by Department of: Adopted by Council: Date a-aa o Adoption Certified by Council Secretary BY � � c� � �: r - Apgroved by Mayor: Date �V1�,� ��Q �/Q BY: /� ��-�`/�� Form Approved by City Attorney B y = Approved by Mayor for Submission to Council By: � id Mayor Norm Coleman's office �racr a�asor� a aHOne Lucia Lehens 6-8533 5 � TOTAL � OF SlGNA7URE PAGES GREEN SHEET 00 -51 � No 105959 u�� u��— Q �..,.� ❑ �.«� ❑ �,�.�. ❑ �,� ❑-�� ❑ (CIIP ALL LOCATIONS FOR SIGNATURE) Approval of the appointment of Sherri Mortenson-Brown and reappomntment of Nancy Dudley Relly to serve on the City of Saint Paul Civil Service Commission PL4NNING COMMISSION CIB COMMI7TEE CNIL SERVICE CAMMISSION SOURCE INFORMATON (IXPWIn s Hes mia ro�rm eoer w«kea under a conVa�t ror mis tlepaAmenl? VES • NO Hm thk P�� e�w been e dry empbyee7 YES NO oaes mie aeBOrJfirm a�sc a swil� noc norme�ypossesaea by am current citv emobreeT VES NO Is ihie pnsoNOrm a tarpeted �endart YES NO dain dl vea s��s m seoarate shcet end aCxh to nreen sheet COET/REYENUEBUDOETWICIRCLEON� YEa NO ACTMTY NWIBER R�'��3 �s'@S1t�C .... � �� ' .: , �: ��! ��':. oo-S1� CITY OF SAINT PAUL 390 Ciry Ha(1 Norm Co[eman, Mayor IS West Kellogg Boulevard Saint Paul, MN 55102 TO: Saint Paul Citv Councilmembers Council President Dan Bostrom FROM: DATE: RE: Councilmember Jay Benanav Councilmember Jerry Blakey Councilmember Chris Coleman Councilmember Patrick Harris Councilmember Kathy Lantry Councilmember James Reiter Lucia Lebens�I��Y � Assistant to the Ma�r DZay 19,2�00 City of Saint Pau] Civil Service Commission Telephone: 612-266-8510 Facsimile: 612-266-8513 ��u?�' � t2" = �:;'° � v :t?;".�i '��i � � 20�0 Mayor Coleman has recommended the appointment of Sherri Mortenson-Brown and the reappointment of Nancy Dudley Kelly to serve on the City of Saint Panl Civil Service Commission. Sherri Mortenson-Brown shall serve the remainder of Harry Gastons' unexpired term. .�ttached is a copy of the resolution nominating these individuals, a copy of Sherri NTortenson-Brown's application and an applicant report listing applicants on file since January, 1999. Feel free to contact me at 266-8533 if you have any questions regarding these appointments. Attachments c: Mark Robertson, Human Resources Department � 00 -Stc. � � � • i � a� . .. �,. . y �.�. ... �.. �TTEE : CSC Civil Service CotmLission FY7R APPLIC'ATIONS DATED AFTER Ol/Ol/99 .�� APPLIC�Nr / REEEREDTCE Ct�P�lI'S WARD PLI�NNING SE�97.'� APP DATE ETH GII�T DIS DISI`RZCP DISPRICT (PRIOR) (O7�IER C�TI'F�4 SII2VLNG ON) ----------------------------------- ---- -------- -------- -------- --- --- --- 002944 Brown, Sherri Mortenson 2 16 OS/17/00 W F 10 Victoria S. Truth 7n Housing St. Paul, MN 55105 Home - 291-9189 133 E. 7th Street St. Paul, MN 55101 Work - 296-4024 FAX 2969434 Policy Analyst, Dept. Cotcecierce Valerie Whitehead 1951 Montreal St. Paul, NA�d 55116 H) 698-9652 12-28-98 HPC; P.C. and NST (STAR): Mayor Noxm Cole�n 390 City Hall, 55102 A1l�rto Quintela, Jr. 390 City Hall, 55102 000001 Carza, Roy #430 400 Selby Avenue St. Paul, ML�T 55102 Home - 651/917-8698 2 16 65 08j13J99 H M Affirniative Action Cor[¢nittee Allina Health Systems Work - 651/220-8476 Health Care Administrator Nov. 20, 1996 Hi.mian Rights Conanission Applicant listed himself as only reference 2-27-95 Hutt�t1 Rights C�rr:�ssio;l Applicant listed himself as only reference 8-13-99 Civil Senrice Cor[mussion Fred Haider City of St. Paul Human Resources w) 266-8510 eo•51(0 OS-19-00 Q'X�M�IITI�E APPLICANI'S RER�RT APPLICPNPS.RIYT' COTM�IITZ�;E : CSC Civil Senrice Ccxmtission Ft�R APPLIC7�'IONS DATID AFPER Ol/Ol/99 ... v �i : �y�: �� s�uui��ri_, GilbPSt De Iao 291 E. Concord h) 292-0592 w) 227-9291 I• •� Y�RD PLAN�IING GFTTA'r'F' APP DATE EI'H C�T DIS DISI'RSCT DISTRICT (PRIOR) (0'I�IER COPM'II'ITF,ES SERVSDTG ON) -- ---- ------ ------ ------- --- --- -- DEC-2B-9B 1g:5B FROM=STA2� MN COMMERGE iD= � f c� 't' �r ,�� ' x�� HameP r:• L>_, Telep6one Nmnber: PSanaiug Dishict Cossncil: Preferred Ma�g Addms: OFFICE OF THE MAYOR 390 CTTY HALL SAA�iT PAIIL, MIIZIIESOTA SSIQZ Yhoaa 266-5525 FAX: 2fi6-8513 �AL£ 1/2 cD-S�{ � : . i �. � 1; ,��• . l: �� , d - � 1 : :� � , ,. . � • . i 1 . �_ 1� 11 Whst is pour occapstioaY ,�S Piacc of E�splopmsnr t:�,�� l WTnat s[c�ls, truiiziag or eiperieace do you poscess for the for whicC� you seek apgointment? oanc;�t oh k7� 6� �fi��5 r�� UoI��.-F�e�r,�urh,�-�a�7 � ��y�tO��fj-.� v� T�e �bfurt�tatiab "�sc4�dr� w this sppt�cafiou u consi �vatc dafa according to che 1Vlianeso�.s Governmeat Aata Practices Ack As a resnit, lhis iaformatiou is ant released w i3se generai pub2ii (OYEB.} Rev_ 8-5-97 TOTRL P.04 CommitCee(s} Appiied.For: � V�,�C �� l� � �GQ Y\i+� t 1'� G1 � L] tnn 4v� i C,�,3 � vl � DEC-2B-9B 14:SB FROM=STAT£ MN COMMERGE lU: x�: Aaa�� Q�� x�� aaar�: PaonG Nam� Addreas: � �. +...Y� � .. . �.?��. � . ► y _ CMVG L/L �'S�` • �:1, 1.: Rrasoas�foryo�ariuter�sEiafhispartitviBrCIImatittef:�S R V�ncinP�[.7NP� �ttn �4tY V1For'"�l�"T � Yn au attempt to emwre that armmittrx represeafation refiects thr malcenp af our cominunidy, please ciieck tlie Gne app3icabic W yoa This inEnnns6oa is shictiy volu»tary: x Wkite (Cancss'ssuj Blaek (African AmericRnj Ameritan Indisn or Aiaskan Eskimo I� IIisabled: Yes �_ �unale 1�i0 Tf speciat accommndatians are needed, please specifp: H"�,sganic Asian ar Padfic Islander Daze of BirW: �oiv did you hesr about t6is o�ng? �: , „ ►: , .. �Q:i�`� a ��.,__ ►:[�r��w.,i�r•z•� - Have you had previons coatsct wifh the commiftee foe which ynu are ma[cing agplitstion? 7f so, when, and the circumsEancea' ORIGINAL Council File # 00� S l� creen sheet # IctSqSq RESOLUTION CITY OF SAINT PAUL,IVIINNESOTA Presented By Referred To Committee: Date � i 2 3 4 5 6 � a 9 io ii iz 13 14 RESOLVED, that the Saint Paul City Council consents to and approves of the appointment and reappointment, made by the Mayor, of the following individuals to serve on the CITY OF SAINT PAUL CIVIL SERVICE COMMISSION. APPOINTMENT REAPPOINTMENT Sherri Mortenson-Brown Nancy Dudley Kelly Sherri Mortenson-Brown shall serve the remainder of Harry Gastons' unexpired term. This term shall expire on June 13, 2002. Nancy Dudiey Kelly shall serve a six-year term which will expire on June 13, 2006. 15 Requested by Department of: Adopted by Council: Date a-aa o Adoption Certified by Council Secretary BY � � c� � �: r - Apgroved by Mayor: Date �V1�,� ��Q �/Q BY: /� ��-�`/�� Form Approved by City Attorney B y = Approved by Mayor for Submission to Council By: � id Mayor Norm Coleman's office �racr a�asor� a aHOne Lucia Lehens 6-8533 5 � TOTAL � OF SlGNA7URE PAGES GREEN SHEET 00 -51 � No 105959 u�� u��— Q �..,.� ❑ �.«� ❑ �,�.�. ❑ �,� ❑-�� ❑ (CIIP ALL LOCATIONS FOR SIGNATURE) Approval of the appointment of Sherri Mortenson-Brown and reappomntment of Nancy Dudley Relly to serve on the City of Saint Paul Civil Service Commission PL4NNING COMMISSION CIB COMMI7TEE CNIL SERVICE CAMMISSION SOURCE INFORMATON (IXPWIn s Hes mia ro�rm eoer w«kea under a conVa�t ror mis tlepaAmenl? VES • NO Hm thk P�� e�w been e dry empbyee7 YES NO oaes mie aeBOrJfirm a�sc a swil� noc norme�ypossesaea by am current citv emobreeT VES NO Is ihie pnsoNOrm a tarpeted �endart YES NO dain dl vea s��s m seoarate shcet end aCxh to nreen sheet COET/REYENUEBUDOETWICIRCLEON� YEa NO ACTMTY NWIBER R�'��3 �s'@S1t�C .... � �� ' .: , �: ��! ��':. oo-S1� CITY OF SAINT PAUL 390 Ciry Ha(1 Norm Co[eman, Mayor IS West Kellogg Boulevard Saint Paul, MN 55102 TO: Saint Paul Citv Councilmembers Council President Dan Bostrom FROM: DATE: RE: Councilmember Jay Benanav Councilmember Jerry Blakey Councilmember Chris Coleman Councilmember Patrick Harris Councilmember Kathy Lantry Councilmember James Reiter Lucia Lebens�I��Y � Assistant to the Ma�r DZay 19,2�00 City of Saint Pau] Civil Service Commission Telephone: 612-266-8510 Facsimile: 612-266-8513 ��u?�' � t2" = �:;'° � v :t?;".�i '��i � � 20�0 Mayor Coleman has recommended the appointment of Sherri Mortenson-Brown and the reappointment of Nancy Dudley Kelly to serve on the City of Saint Panl Civil Service Commission. Sherri Mortenson-Brown shall serve the remainder of Harry Gastons' unexpired term. .�ttached is a copy of the resolution nominating these individuals, a copy of Sherri NTortenson-Brown's application and an applicant report listing applicants on file since January, 1999. Feel free to contact me at 266-8533 if you have any questions regarding these appointments. Attachments c: Mark Robertson, Human Resources Department � 00 -Stc. � � � • i � a� . .. �,. . y �.�. ... �.. �TTEE : CSC Civil Service CotmLission FY7R APPLIC'ATIONS DATED AFTER Ol/Ol/99 .�� APPLIC�Nr / REEEREDTCE Ct�P�lI'S WARD PLI�NNING SE�97.'� APP DATE ETH GII�T DIS DISI`RZCP DISPRICT (PRIOR) (O7�IER C�TI'F�4 SII2VLNG ON) ----------------------------------- ---- -------- -------- -------- --- --- --- 002944 Brown, Sherri Mortenson 2 16 OS/17/00 W F 10 Victoria S. Truth 7n Housing St. Paul, MN 55105 Home - 291-9189 133 E. 7th Street St. Paul, MN 55101 Work - 296-4024 FAX 2969434 Policy Analyst, Dept. Cotcecierce Valerie Whitehead 1951 Montreal St. Paul, NA�d 55116 H) 698-9652 12-28-98 HPC; P.C. and NST (STAR): Mayor Noxm Cole�n 390 City Hall, 55102 A1l�rto Quintela, Jr. 390 City Hall, 55102 000001 Carza, Roy #430 400 Selby Avenue St. Paul, ML�T 55102 Home - 651/917-8698 2 16 65 08j13J99 H M Affirniative Action Cor[¢nittee Allina Health Systems Work - 651/220-8476 Health Care Administrator Nov. 20, 1996 Hi.mian Rights Conanission Applicant listed himself as only reference 2-27-95 Hutt�t1 Rights C�rr:�ssio;l Applicant listed himself as only reference 8-13-99 Civil Senrice Cor[mussion Fred Haider City of St. Paul Human Resources w) 266-8510 eo•51(0 OS-19-00 Q'X�M�IITI�E APPLICANI'S RER�RT APPLICPNPS.RIYT' COTM�IITZ�;E : CSC Civil Senrice Ccxmtission Ft�R APPLIC7�'IONS DATID AFPER Ol/Ol/99 ... v �i : �y�: �� s�uui��ri_, GilbPSt De Iao 291 E. Concord h) 292-0592 w) 227-9291 I• •� Y�RD PLAN�IING GFTTA'r'F' APP DATE EI'H C�T DIS DISI'RSCT DISTRICT (PRIOR) (0'I�IER COPM'II'ITF,ES SERVSDTG ON) -- ---- ------ ------ ------- --- --- -- DEC-2B-9B 1g:5B FROM=STA2� MN COMMERGE iD= � f c� 't' �r ,�� ' x�� HameP r:• L>_, Telep6one Nmnber: PSanaiug Dishict Cossncil: Preferred Ma�g Addms: OFFICE OF THE MAYOR 390 CTTY HALL SAA�iT PAIIL, MIIZIIESOTA SSIQZ Yhoaa 266-5525 FAX: 2fi6-8513 �AL£ 1/2 cD-S�{ � : . i �. � 1; ,��• . l: �� , d - � 1 : :� � , ,. . � • . i 1 . �_ 1� 11 Whst is pour occapstioaY ,�S Piacc of E�splopmsnr t:�,�� l WTnat s[c�ls, truiiziag or eiperieace do you poscess for the for whicC� you seek apgointment? oanc;�t oh k7� 6� �fi��5 r�� UoI��.-F�e�r,�urh,�-�a�7 � ��y�tO��fj-.� v� T�e �bfurt�tatiab "�sc4�dr� w this sppt�cafiou u consi �vatc dafa according to che 1Vlianeso�.s Governmeat Aata Practices Ack As a resnit, lhis iaformatiou is ant released w i3se generai pub2ii (OYEB.} Rev_ 8-5-97 TOTRL P.04 CommitCee(s} Appiied.For: � V�,�C �� l� � �GQ Y\i+� t 1'� G1 � L] tnn 4v� i C,�,3 � vl � DEC-2B-9B 14:SB FROM=STAT£ MN COMMERGE lU: x�: Aaa�� Q�� x�� aaar�: PaonG Nam� Addreas: � �. +...Y� � .. . �.?��. � . ► y _ CMVG L/L �'S�` • �:1, 1.: Rrasoas�foryo�ariuter�sEiafhispartitviBrCIImatittef:�S R V�ncinP�[.7NP� �ttn �4tY V1For'"�l�"T � Yn au attempt to emwre that armmittrx represeafation refiects thr malcenp af our cominunidy, please ciieck tlie Gne app3icabic W yoa This inEnnns6oa is shictiy volu»tary: x Wkite (Cancss'ssuj Blaek (African AmericRnj Ameritan Indisn or Aiaskan Eskimo I� IIisabled: Yes �_ �unale 1�i0 Tf speciat accommndatians are needed, please specifp: H"�,sganic Asian ar Padfic Islander Daze of BirW: �oiv did you hesr about t6is o�ng? �: , „ ►: , .. �Q:i�`� a ��.,__ ►:[�r��w.,i�r•z•� - Have you had previons coatsct wifh the commiftee foe which ynu are ma[cing agplitstion? 7f so, when, and the circumsEancea' ORIGINAL Council File # 00� S l� creen sheet # IctSqSq RESOLUTION CITY OF SAINT PAUL,IVIINNESOTA Presented By Referred To Committee: Date � i 2 3 4 5 6 � a 9 io ii iz 13 14 RESOLVED, that the Saint Paul City Council consents to and approves of the appointment and reappointment, made by the Mayor, of the following individuals to serve on the CITY OF SAINT PAUL CIVIL SERVICE COMMISSION. APPOINTMENT REAPPOINTMENT Sherri Mortenson-Brown Nancy Dudley Kelly Sherri Mortenson-Brown shall serve the remainder of Harry Gastons' unexpired term. This term shall expire on June 13, 2002. Nancy Dudiey Kelly shall serve a six-year term which will expire on June 13, 2006. 15 Requested by Department of: Adopted by Council: Date a-aa o Adoption Certified by Council Secretary BY � � c� � �: r - Apgroved by Mayor: Date �V1�,� ��Q �/Q BY: /� ��-�`/�� Form Approved by City Attorney B y = Approved by Mayor for Submission to Council By: � id Mayor Norm Coleman's office �racr a�asor� a aHOne Lucia Lehens 6-8533 5 � TOTAL � OF SlGNA7URE PAGES GREEN SHEET 00 -51 � No 105959 u�� u��— Q �..,.� ❑ �.«� ❑ �,�.�. ❑ �,� ❑-�� ❑ (CIIP ALL LOCATIONS FOR SIGNATURE) Approval of the appointment of Sherri Mortenson-Brown and reappomntment of Nancy Dudley Relly to serve on the City of Saint Paul Civil Service Commission PL4NNING COMMISSION CIB COMMI7TEE CNIL SERVICE CAMMISSION SOURCE INFORMATON (IXPWIn s Hes mia ro�rm eoer w«kea under a conVa�t ror mis tlepaAmenl? VES • NO Hm thk P�� e�w been e dry empbyee7 YES NO oaes mie aeBOrJfirm a�sc a swil� noc norme�ypossesaea by am current citv emobreeT VES NO Is ihie pnsoNOrm a tarpeted �endart YES NO dain dl vea s��s m seoarate shcet end aCxh to nreen sheet COET/REYENUEBUDOETWICIRCLEON� YEa NO ACTMTY NWIBER R�'��3 �s'@S1t�C .... � �� ' .: , �: ��! ��':. oo-S1� CITY OF SAINT PAUL 390 Ciry Ha(1 Norm Co[eman, Mayor IS West Kellogg Boulevard Saint Paul, MN 55102 TO: Saint Paul Citv Councilmembers Council President Dan Bostrom FROM: DATE: RE: Councilmember Jay Benanav Councilmember Jerry Blakey Councilmember Chris Coleman Councilmember Patrick Harris Councilmember Kathy Lantry Councilmember James Reiter Lucia Lebens�I��Y � Assistant to the Ma�r DZay 19,2�00 City of Saint Pau] Civil Service Commission Telephone: 612-266-8510 Facsimile: 612-266-8513 ��u?�' � t2" = �:;'° � v :t?;".�i '��i � � 20�0 Mayor Coleman has recommended the appointment of Sherri Mortenson-Brown and the reappointment of Nancy Dudley Kelly to serve on the City of Saint Panl Civil Service Commission. Sherri Mortenson-Brown shall serve the remainder of Harry Gastons' unexpired term. .�ttached is a copy of the resolution nominating these individuals, a copy of Sherri NTortenson-Brown's application and an applicant report listing applicants on file since January, 1999. Feel free to contact me at 266-8533 if you have any questions regarding these appointments. Attachments c: Mark Robertson, Human Resources Department � 00 -Stc. � � � • i � a� . .. �,. . y �.�. ... �.. �TTEE : CSC Civil Service CotmLission FY7R APPLIC'ATIONS DATED AFTER Ol/Ol/99 .�� APPLIC�Nr / REEEREDTCE Ct�P�lI'S WARD PLI�NNING SE�97.'� APP DATE ETH GII�T DIS DISI`RZCP DISPRICT (PRIOR) (O7�IER C�TI'F�4 SII2VLNG ON) ----------------------------------- ---- -------- -------- -------- --- --- --- 002944 Brown, Sherri Mortenson 2 16 OS/17/00 W F 10 Victoria S. Truth 7n Housing St. Paul, MN 55105 Home - 291-9189 133 E. 7th Street St. Paul, MN 55101 Work - 296-4024 FAX 2969434 Policy Analyst, Dept. Cotcecierce Valerie Whitehead 1951 Montreal St. Paul, NA�d 55116 H) 698-9652 12-28-98 HPC; P.C. and NST (STAR): Mayor Noxm Cole�n 390 City Hall, 55102 A1l�rto Quintela, Jr. 390 City Hall, 55102 000001 Carza, Roy #430 400 Selby Avenue St. Paul, ML�T 55102 Home - 651/917-8698 2 16 65 08j13J99 H M Affirniative Action Cor[¢nittee Allina Health Systems Work - 651/220-8476 Health Care Administrator Nov. 20, 1996 Hi.mian Rights Conanission Applicant listed himself as only reference 2-27-95 Hutt�t1 Rights C�rr:�ssio;l Applicant listed himself as only reference 8-13-99 Civil Senrice Cor[mussion Fred Haider City of St. Paul Human Resources w) 266-8510 eo•51(0 OS-19-00 Q'X�M�IITI�E APPLICANI'S RER�RT APPLICPNPS.RIYT' COTM�IITZ�;E : CSC Civil Senrice Ccxmtission Ft�R APPLIC7�'IONS DATID AFPER Ol/Ol/99 ... v �i : �y�: �� s�uui��ri_, GilbPSt De Iao 291 E. Concord h) 292-0592 w) 227-9291 I• •� Y�RD PLAN�IING GFTTA'r'F' APP DATE EI'H C�T DIS DISI'RSCT DISTRICT (PRIOR) (0'I�IER COPM'II'ITF,ES SERVSDTG ON) -- ---- ------ ------ ------- --- --- -- DEC-2B-9B 1g:5B FROM=STA2� MN COMMERGE iD= � f c� 't' �r ,�� ' x�� HameP r:• L>_, Telep6one Nmnber: PSanaiug Dishict Cossncil: Preferred Ma�g Addms: OFFICE OF THE MAYOR 390 CTTY HALL SAA�iT PAIIL, MIIZIIESOTA SSIQZ Yhoaa 266-5525 FAX: 2fi6-8513 �AL£ 1/2 cD-S�{ � : . i �. � 1; ,��• . l: �� , d - � 1 : :� � , ,. . � • . i 1 . �_ 1� 11 Whst is pour occapstioaY ,�S Piacc of E�splopmsnr t:�,�� l WTnat s[c�ls, truiiziag or eiperieace do you poscess for the for whicC� you seek apgointment? oanc;�t oh k7� 6� �fi��5 r�� UoI��.-F�e�r,�urh,�-�a�7 � ��y�tO��fj-.� v� T�e �bfurt�tatiab "�sc4�dr� w this sppt�cafiou u consi �vatc dafa according to che 1Vlianeso�.s Governmeat Aata Practices Ack As a resnit, lhis iaformatiou is ant released w i3se generai pub2ii (OYEB.} Rev_ 8-5-97 TOTRL P.04 CommitCee(s} Appiied.For: � V�,�C �� l� � �GQ Y\i+� t 1'� G1 � L] tnn 4v� i C,�,3 � vl � DEC-2B-9B 14:SB FROM=STAT£ MN COMMERGE lU: x�: Aaa�� Q�� x�� aaar�: PaonG Nam� Addreas: � �. +...Y� � .. . �.?��. � . ► y _ CMVG L/L �'S�` • �:1, 1.: Rrasoas�foryo�ariuter�sEiafhispartitviBrCIImatittef:�S R V�ncinP�[.7NP� �ttn �4tY V1For'"�l�"T � Yn au attempt to emwre that armmittrx represeafation refiects thr malcenp af our cominunidy, please ciieck tlie Gne app3icabic W yoa This inEnnns6oa is shictiy volu»tary: x Wkite (Cancss'ssuj Blaek (African AmericRnj Ameritan Indisn or Aiaskan Eskimo I� IIisabled: Yes �_ �unale 1�i0 Tf speciat accommndatians are needed, please specifp: H"�,sganic Asian ar Padfic Islander Daze of BirW: �oiv did you hesr about t6is o�ng? �: , „ ►: , .. �Q:i�`� a ��.,__ ►:[�r��w.,i�r•z•� - Have you had previons coatsct wifh the commiftee foe which ynu are ma[cing agplitstion? 7f so, when, and the circumsEancea'