04-319Eunc1T File # V �� J'
Green Sheet # �� 3 � p
Presented By
Referred To
RESOLVED, that the Saint Paul City Council consents to and approves the appointments and
reappointments, made by the Mayor, of the following individuals to serve on the Yonth Fund Board.
2
4
5
6
10
11
12
13
14
15
16
17
REAPPOINTMENTS
18 William (Billy) Collins - representing Adult/Ward 1- term expires March 23, 2005
19 Jim Kelley - representing Adult/Ward 4- term expires March 23, 2005
20 Miriam Rykken - representing Adult/Ward 3- term expires March 23, 2005
21
23
24
25
26
27
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
�
Committee: Date
APPOINTMENTS
Margaret (Peggy) Laub - representing Adult/Ward 6- term expires March 23, 2005
Tegan McDonough - representing Youtl�/Ward 6- term expires March 23, 2005
Ronald Moccia - representing Adult/At Large - term eapires March 23, 2005
Maddie Orenstein - representing Youth/Ward 3- term e�ires March 23, 2005
Jessica Wright - representing Youtl�/Ward 4- term expires March 23, 2005
Kurt Zilley - representing Adult/Ward 7- term expires March 23, 2005
� Green Sheet Green Sheet
o�{- 3�9
Green Sheet Green Sheet Green Sheet Green Sheet
�
DepartmenUoffice/councit: Date Initiated:
Mo -�a,�s�� ,�-�� Green Sheet NO: 3013578
CoMact Person 8 Phone- ���eM SeM To Person InitiaVDate
Kurt Schultz � 0 's �
Z66&590 ASSign 1 or's ffice De rtmentDirector
Must Be on Council /�qenda by (Date): Number 2 • Attorne -
For
Routing 3 or's OtLce Ma or/Assistaot
Oftler 4 ouncil
5 i Clerk Ci Clerk
7otal # of Signature Pages _(Clip All Locations for Signature)
Action Requested:
Approval of the appoinhnents, made by the Mayor, of Mazgaret (Peggy) Laub, Tegan Mcdonougty Ronald Moccia, Maddie
Orenstein, 3essica Wright and Kurt Ziley and the reappoinhnents of William (Billy) Collins, Jim Kelley, and Miraim Ryken to serve on
the Youth Fund Boazd. All terms shall exp'ue on Mazch 23, 2005.
Recommentlations: Approve (A) or Rejec[ (R): Personal Service Contrects Must Answer the Following Questions:
Planning Commission 1. Has this person/firm ever worked under a contract for this departmenY?
CIB Committee Yes No
Civil Service Commission 2. Has this persoNfinn ever been a city employee?
Yes No
3. Dces this personffirm possess a skill not normally possessed by any
current city employee?
Yes No
Explain all yes answers on separate sheet antl atWCh to green sheet
Initiating Problem, Issues, Opportunity (Who, What, When, Where, Wh»:
AdvanWges If Approved:
Disadvanqges If Approvetl:
Disadvantages If Not Approved:
ToWlAmountof CosURevenue Budgeted:
Transaction: � ��r�;��,�.3� �?�,,,�.�e
Funding Source: Activity Number:
Financiallnformatlon: AAA� '9 � ���x
(Explain) r P/-'l .g d ��g�g� .
ay- 3�°I
CITY OF SAINT PAUL 390 Ciry Hall
Randy C. KelLy, Mayor IS West Kellogg Boulevard
Saint Paul, MN 55102
To: Saint Paui City Councilmembers
Council President Dan Bostrom
Councilmember Jay Benanav
Councilmember Pat Harris
Councilmember L,ee Helgen
Councilmember Kathy Lantry
Councilmember Debbie Montgomery
Councilmember Dave Thune
From: Kurt Schuitz
Date: March 17, 2004
RE: Youth Fund Board
Telephone: 651-266-8510
Facsimi[e: 651-266-8513
Mayor Kelly has recommended the appointrnents of Margaret (Peggy)
Laub, Tegan McDonough, Ronald Moccia, Maddie Qrenstein, Jessica
Wright and Kurt Zilley, and to the Youth Fund Boazd. Their terms shall
expire on March 23, 2005.
Mayor Kelly has also recommended the reappoinhnents of William (Billy)
Collins, Jim Kelley, and Miriam Rykken to the Youth Fund Board. Their
terms shall expire on March 23, 2005.
Attached is a copy of the resolution nominating these individuals as well
as the applications for the new appointments. Please remember that
certain information on the applications is classified as private and should
not be released to the public.
Feel free to contact me at 266-6590 if you have any questions regarding
these appoinhnents and reappointments.
Attachments
cc. Eric Thompson
� � �:; �� �„�f.�„
� �._. � . -��.,- . _
i°;?� � `� 2���
�
�
D �l- 3i9
RECE ;VE�
Application for Committee, Board, or Commission �UL 31 20�2
Please return to Mark Engebretson
Mayor's Office, Room 390 City Hall
15 West Kellogg Blvd., Saint Paul, MN 55102 �nAYOR CrF;C`
Phone:651-266-8533 Fax:651-266-8513
?he Minneso�a Goeernment Data Praccices Act (Mianeso[a Sta[utes Chapcer 13) �over¢s �he City's use of the
informaciou coa�ained ln iliis appLcation. Some of the informatiou soughi in this appLicaxion is pri.�ate da�a under the
Ac[. The requested iuformation «•Lll be used by [he appoin[ing au[horit}� [o carry ou[ the Ci�S�s official appointmeat
rzsponsibilities. You are not required to provide any information. Howe+�er, failure to ans�.•er the applica�ion questions
may cause t6e appointiug authority [o rejecn yout application. T6e majo[iry of items comained ia �his application ace
publiu, includin� ne+ne, address, employment, skills, trainin� and experience, and afe tl�erefore available to anyoue
requestin� ic. The remaiui¢g iwms on t6t applicatiou form are classiffed as pri�ate. The pru•ate data �s available only to
yuu and to other persons in the �ity who, because of work assignmen[s, reasonabiy rzqurte access [o Ihe information.
I�ame f/'J�yY
�°�
Home address
Telephones
PI<aseinclude
E-mail add:
�U �
Planning District Council City Council Ward �'
Preferred mailing address '�ry�e a S Q.66Ye
s'seet c�ty stam ��p
� • ._
Occupation
Place of employment C(�.���Q n, J.L6�
Employment address '� � "' ����-� Sl.0 � �.3ea
Committee(s}-appliedfot ��-h �____ rr�h'1" {�pLr�e� ''
What skills/training or experience do you possess for the committee(s) for which you seek
appointment?
����i��+���3i � � JI�"Lv't�l,�l�1Z.t��sLt��s�t��.r�
/
, ,.
,
�
PersonalReferences
Name
o y- 3I9
Address�r1� � � ,�'. �Q�� � � N � ll(D
>
Telephones ��ys�) �9� -�y1�9�
Please include Area Codes home wo:k ,.rx..
I�ame
Addre
Telephoaes�(o51) - �7Lo_QSt3s'�l �(e1__�)_Q)a - �� g
Please include Area Codes holce work ,..hP.
I�'ame
Addre
Telephones � �
Piease include Area Codes home
�
work
Reasons for your interest in this particular committee
Have you had previous contact with the committee for which you are making application?
If so, when, and under what circumstances?
. _ � _
In an attempt to ensure that committee representation reflects the makeup of our community,
please check the box applicable to you. This information is strictly voluntary.
�White (Caucasian) � Hispanic �Black (African-American)
� Asian or Pacific Islander � American Indian or Alaskan Eskimo
� Male Female � Date of birth �� J) c7��
Disabled: � Yes No �'
If special accommodations are needed, please specify
How did you hear about this opening? ^ YiC /hoin�,r�f01t
page 2 of2
�
oy- 31°1
Appiication for Committee, Board, or Commission
Please return to Mark Engebretson
Mayor's Office, Room 390 City Hall
15 W est Keilogg Blvd., Saint Paul, MN SS IQ2
Phone:651-266-8533 F ax:651-266- 8 5 13
'Lhe Minnesota Government Dnta Practices 9ct (Minnesota S�atutes Chnpter 13) goveres tht City's use of the
informaiion concained in this application. Some of the information sought in this application is private data under the
Act. The tequested information will be used by the appointing authocity to carry out the City's official appointmznt
responsibilities. You are not required to provide any information. However, faiiuse to answer che application yuestions
map cause the appuinting xuthurity to reject your application. 7he majerity of items contained in [his xpplication are
public, including rtame, address, employment, skills, training and experience, and are theeefore available to aoyune
requesting iL The remaining items on [he xpplication form are cJa:sified as priva[e. The private data is nvailable ortly to
you anA ��o person in the City who, 6ecause pfwork asaignment., reasonably require access to the information.
��3R1CI1l.i�� IIIIAI �� �,��IY1����
Homeaddress ��'� '�, ����
Telephones �- - 1�_�j�
Please includeArea (;odes
E-mail address -��,1 7- �J
Planning District Counci] S
Preferred mailing address
Occupation
Place of employment
Employment address
Committee(s) applied for
0�
�
City Council Ward 6
page 1 of2
�Vhat skills/training or experience do yau possess for the committee(s) for which you seek
appointment?
�
, j -
ii
,
PersonaI References
Name
Addre
Telep
Please incluae Area (;otles
Name ��h �,��
Address
Telephones
PlensP :^^�••ae e.e., n..ae..
Name
Addre
Telephones
Please include 9rea Codes home
work
Reasons for your interest in this particular committee
D�- 319
o�her
0
Have you had previous contact with the committee for which you are making application?
If so, when, and under what circumstances`?
9 �_n.
In an attempt to ensure that committee representation reflects the makeup of our community,
please check the box applicable to you. This information is strictly voluntary.
�White (Caucasian) � Hispanic � Black (African-American)
� Asian or Pacifie Islander � Amexican Indian or Alaskan Eskimo
� Male Female � Date of birth G 21
Disabled: � Yes No �
If special accommodations are needed, please specify
How did you hear about this opening?
page 2 of 2
�l'�
home work other
x ,.�.. ., .._ . ..—_
... . OFFICE OF TSE MAYOR
390 CITY HALZ,
SAINT PAIIL� MINNESOTA 55102
266-8525_ FAX: 266-8513
Name: lfAiJA-j� fn�_ �1Fr�rid �.,._ �
�<� °`�� �u� �
FEB 0 8 2fl02
Home Address:
Street
Citp
�
�
Telephone Number. (Home)�/p�1��vy7 �0�l1 a CAorkll6S/ ,�5��—�b �/6 (�p,X)
Planning District Cauncil: L �1r.�l�tu� �l� Citp Council �7a=d:
P=eferted Hailing Address: [�(pO - /9ti,p Sr.PA„/� �� `�S/jsL�
Ahat is youx occupation? �(?-JL7"•`1�i 2� �2��7"i ff
Place �oY Employment: �T / ,/LD rX /�2'�O�R�i / i�� � /} .
Co�ittee(s) Applied For: �, pit�l Y U� P/!�y/G/�-yv�,s ��-,u�' /�OR�L,,,�
,
Ahat skills/training or esperience do you possess for the committee(s) £or vhich you seek
appointment?
r,
04Lf..9�.
i�+.
�
i.Stsi✓/•i
+�-st_
��h'1—
t�i':.n;,;e
. .
`��- o,z-� �%�l�,s . . I
.
;�.� �.v .7'%� .✓of ���d
�S . f�►„ o � �t.✓i T� l-� is/a �
ti�(/� � �Pi�l�GIL 'd'� [2e . .
64�d . � �e�-l.� �1.� : _� q
�-•.` �-- ,-,�v��c y s�- un e, ny- � �x.. R� � rA- ;�° -qshC L�'�.:.� r p,,. I�-e
i
bo.�.�.
The information included i.n this application is considered private data according to the
Hinnesota Goverment Data Practices Act. As a result, this information is not zeleased to
the general public,
(OVEIL)
Rev.4/21/93
PERSONAL REFERENCES O� �/ Q
Name: �ji�l �C��nNs01'� 7
Address: �O ! 7 /�• /%�S . �� �i�-J� _ /�7/`"i ,���1 9
Yhone
Name: �/h✓ �/9"�.1/"�A'I�
Address: � -�� ��
Phone
Aame
i f�srul /'�,� -
��i
39- ��6 7
��
Address: ���J W y/✓N ¢. �}l�i � I � /�ih�t� /��� 5����
Phone: CHome) I� 3,' � GY� '�S a� l�ork) �� ro `/.3 =�'l 7/
Reasons for youx interest in this particulax committee:
�
�
Have pou had previous contact with the committee for vhich you are making application. -
I£ so, vhen, and circumstances?
. � - ,_- .,
In an attempt to ensure that committee representation re£lects the makeup of our
community, please check the line applicable to you. This i.nformation is strictly
voluntaiy.
��
Qhite (Caucasian) Hispazic
Black (African American) Asian or Paci£ic Islander
American Indian or Alaskan Eskimo
� Male ,` /
Female Date oE Birth: �/� 7�(D�
Disabled: Yes No �
If special acco�odations are needed, please specify. ���i"
Hov did you hear about this opening? i•(yMilerLS � ��^x-
�
o�- 3� 9
Application for Committee, Board, or Commission
Please return to Mark Engebretson
Mayor's Office, Room 390 City Hall
15 West Kellogg Blvd., Saint Paui, MN 55102
Phone:651-266-8533 Fax:651-266-8513
The Minnesota Government Da[a Practices Act (Minnesota Statutes Chapter t3) governs the City's use of the
information concained in this appiication. Some of the information sought in this apptication is private data under the
Act. The requested information will be used by the appointing auchority to carry out ihe City's official appointment
responsibilities. You are not required to provide any information. However, failure to answer the applicaCion questions
may cause the appointing authority to reject your application. The majority of items contained in this application are
public, including name, address, employment, skills, training and experience, and are therefore available to anyone
requesting it. The remaining icems on tfie application form are classified as private. The private data is available only tc
you and to other pecsons in the City who, because of wock assignments, ceasonably cequire access co che information.
�/\r _ '. - �, f�.��..., 1� ' '�
Name � '�� � ! � � '
� A� �F .�
Home address - �' •�:-;-. ; . - ...!-- � -.._.'�. �„f,� � � 1 i GC=.,
,
, ' sneea eiry stsxe � zip �
ti
' ,� ,
Telephonas � }!� �c; ' "�Lt � � f-c ,�f � -/"�-_ _ _
PleaSeinclutleA�eaCodes - � � � home work fax
4 T
f' . :
E'TR3113d(1LBSS I � \� � ; �`�. f ,�`� `�.. �' —. �,�., ,'iY i
Planning District Council
Prefeiced maiting address � %� %�� �;��'.,�
� / street
� �1J,% --
Occupation ��!'� ,
Place of employment
Employmentaddress
Committee(s) applied
�`-
Caty Council Ward
�n.
� � �f �/ I� ,�'�' �� i� `.
; l�; i
�
What skillsltraining or experience do you possess for the committee(s) for which you seek
appointment?
�
,, � '
1 c � r � } „ �-�, ���+ �,_� �l�
, I
�� ��U;U�� \�1,�`� ���� L �� � ,�`,,, VS ,
,,
�
".� — r i .� � � � ,� ' :�s� (y �
-:-t, ' '1�!� �� '�.. � ^ �' ' � �� ����,��, L ��-'li�� L
i C�,���'l �t -�-;C�7.'� (� " � �,�_C i1 �. '���� ,�,;,' �
�� — ."�` 1� � . - � ; ' �; �'� � — ', � `; = � - s - n
. � �_ . , ._ ,_1
L r � �-�- ^i_� -;-� `-'n `-� ` _ .
.1 '� �_. i -{,i=�
:rL ` S`� �. �� J 1\ � i�V. �.rt V ��.%_�` �1, - (;` , G; � I \ I`,-� i l�
�, ; �Y" � ' t�'=-r �-4-�.'�.� � {1 �''- � � -. .�. �
�',`�.:� ,�al .0 �� � �1.'� �'�:'l_� �"�f`� . --;�� 1
._ _
�
. - � � _ � �� �T �
( :l \� ,�-, �.r," --� . � ,, r, `c
� �' —; !i t � ` ` r _ � � � _ � - ^'� ; r � i { - v}— � r. .�
, _ - i.'; �
C _� �-�
_
� � ���
n' `v1 < , c�
, '� ✓C�;C:�=
. c`�
� i� �
PersonalReferences -�. ,� '��'�`
, �
, ,,; q ,. �{., ..� _ , ��� - ..,,.
�i
�
�. �•
Address '
Z.�� _ r �L l, — l �j_ -,
Telephones f.�-.-� � �
*' %�-
Please indude Area Codes home
-T �
Name i('� �i i� � '�' `;�at� "�; ; '���
/'Address � -� � ' -r-< —� �,' - i �
�elephones , �-- _ �--, .-� �
, _
r�
Please include ArAa Codes home '
�� � �.�"' �% '� " �YJ'
Name tf: � ,� ;,,, : p'. %� ��
�,. "s-. � ,.;y � " 1��. .r.E�
�` — �
Aaaress C ", � �.� - �
Telephones �C���� ���! �� — �� �
� f, - '�
Please include Area Codes home
1� �i : �; ,
Name t"� : i,._ .��-'" —,-.
Other
other
other
1��,=�-�=- : �
���.
, , . ----�—
�' ��� '+, ; ��. �,�.� �, ;.� t�: �� - -'r —�� � •��� , ,-
> � � .; �� i �"�,� - : r � ��Y2�
Ct; ' C ,.i_�,,; �-, ._ _
Have you had previous contact with the committee for which you are making application?
If so, when, and under what cir_�umstances?
, o�-3r9
"�,�.:; ;,���� r� �.,�_�. - ,:, � _ ,
i � . �L y1L ,��.. _. �, �v���:�,
:-�Nl��u ��_,c.'L i �i�7�:!2!rx:;1 .
work
�. i �
work
work
Reasons for your interest in this particular committee
.- �, �: �" �;--�' �
- i - f� , .�, t C - �" L . s , �U� � -_ + �'� 1
,
In an attempt to ensure that committee representation reflects the makeup of our community,
please check the box applicable to you. This information is strictly voluntary.
>' White (Caucasian) � Hispanic �Black (African-American)
� Asian or Pacific Islander � American Indian or Alaskan Eskimo
� Male Female �' Date of birth —" �� �
Disabled: � yes No'�� �
�
If special accommodations are needed, please specify —
r�
How did you hear about this o enin � ' -`—^ =—� i
P B• _ P\1 �i�.. ,� . -��
page 2 of2
i�
�
o �- 319
Application for Committee, Board, or Commission
Please return to Mark Engebretson
Mayor's Office, Room 390 City Hall
15 West Kellogg Blvd., Saint Paul, MN 55102
Phone:651-266-8533 Fax:651-266-8513
The Minnesota Government Da[a Practices Act (Minnesota Siatuces Chapter 13) governs [he Ci[y's use of [he
informa[ion con[ained in this application. Some of the information sou�ht in t6is applicatiou is priva[e da[a under [he
Act. The requested information will be used by the appointing authority ro carry out the City's officia] appoiniment
responsibilities. You are not required to provide any information. However, failure to answer the application questions
may cause the appoin[ing authority to reject your application. The majority of items contained in [his application are
public, including aame, address, employment, skills, training and experience, and are therefore available to aayone
requesting it. The remaining items on the application form are classified as priva[e. The private data is available only to
you aud to other persons in [he City who, because ofwork assigamen[s, reasonably require access to the informatioa.
Name �� �J" S 1�� �� ��� I"
Home address o`-� (� �" ������ �� S`�1 �Gl��� .M�U
Telephones ����s�'����
Please tuclude Area 1
E-mail address
ln/'� l
Cn�i �
work
C�V�WIVt-t
Planning District Council t� City Council Ward
Preferred mailing address
Occupation �-�`�"��
vp
l �S
Placeofemployment .J!-1'�/�I � l�ilyar�� �i��«�
Employment address 3�� C(� L�/I � l ��- l`�i� �� M N�; iG�
Committee(s) applied for
VI
What skills/training or experience do you possess for the committee(s) for which you seek
appointment?
�_�1CC{�V� Y�'1�( t�XP�'�iVL� tti'C�� 1�1 �1J ��-�-�-<? C(�} � �1Gf V�
�I1Y1�G( G{ -�'l�Ci
Q�G1FlCG I l�/
r T 1�lGt U� i�U
Ot� -f-tn.� C�tgrj-Gjl G
E �t �CG1ti�t�l �� 1-�1Gi� I V�'_ G� t�e1 U�
�1WICVl1�l GI�G''vl-}- -}�V�c2. ►�IP�C��S �� S
i In�v� GtlSo inGo( �=V�.cp�UV�i
���+� �v����� C-�cr�rc 1.1"t��5 I�c
GtrV�C'i C( - } - ���v �e����
%'i!r%�/1 +S i Vt S`� • l�i t, I I.
' �Fc b� ov� -i-i�
Gfl
�P� �L wi� �1 �ov� � r�; �-+-v� �c��� hcvi-I
Gv��i (_eG�rvt Gt�vt-t w�Gt+ � Iwtl'�r �v�
� �Jl � � '� ��' �4� page 1 of2 �1 - �(/t � �iiV1G �
��C'�!� 51-( �'VlbliC,SC�1C'OIS�Z
�iX'��rw� �� s cti �l Cv� vt� �so�l ��'1 s
w � l I�� �h%��iGi� I,
O i' Sfi -(-�'it tit � Gt
� �O�Ol1C�i(
� �� ��
� i+�/
� v � r w v v' P
� rG+C( t�1a-Ic�/.
t�G-F- V� �/
- P�tV� �
/
/�
;
Personal References
Name
o�- 3�9
Address 3�� �� I�� �� � �
Telephones ��
P{easeintlnde Area Cades home work o[her
Name L��lil M�i1�jGi (}-P �-�G �il'���
Address
Telephones
��V �/``' ��� �
r-IC� Gl
��D�O — i
Please inNude Area Codes home
work
other
Name �i((.QQ/�� ��{�Q�
Address �pa� 1V � �� �'� �1.-1- 1 I ' l�� � MJ� �� ��
Telephones ���— �D�3
Please include Area Codes home work other
Reasons for your interest in this particular committee r� G� �.(OVi Vi� G1GRV1 l�
t,�VtO G� (�t�U (�t Y� 1 Vl S°� - 'f�1Vt I � Vl ��'In IS (itJC>"vt l�i(
C-�o�rCl � v�� G►�ti �� CL1�t � c�ra�{ r }-a
�GV1i 1 b Vt� �o -i�1�e. U�y - --
Have you had previous contact with the committee for which you are making application?
If so, when, and under what circumstances?
In an attempt to ensure that committee representation reflects the makeup of our community,
please check the box applicable to you. This information is strictly voluntary.
� White (Caucasian) � Hispanic �Black (African-American)
� Asian or Pacific Islander � American Indian or Alaskan Eskimo
� Male Female`� Date of birth ' ���� �
7
Disabled: � Yes No�
If special accommodations are needed, please specify
How did you hear aUout this opening? �naYGr ��l ! y
page 2 of 2
w -!
��
�
g�CENE
MAR u � 2�02
PLEASE RETURN TO:
LUCILLE JOHNSON
CITIZEN SERVICE OFFICE
15 WEST KELLOGG BLVD.
p�pYOR OP�� EN(65 )266�8690 FAX:
D�f- 3! v�y
a.^• ;�li`J
:,,c.
MAR i 9 2002
`�;i � Y C:LtF�C
Notice of Rights when Providing Information
You are being asked to provide information for your committee application. The attended use of this
information is to evaluate your application. You aze not obligated to provide the information, but without it,
your application may not be considered. Officers, a�ents and employees of the City of Saint Paul will have
access to the information you provide as necessary to the performances of their duries. In addition, the data
mazked with an* is public information and will be available to the general public.
*Name:
�
*Home A�dress• ��l le �l {� �T2�c.�
*City: S � P n�1 `N� h * Zip:
Telephone Number(s):
(Include Area Codes)
Fax Number:
Email Address:
�x� 1�5� ��+�i-t��ra3 � b5t- a�s�
l��il a`d�1-ol�1a
*Planning District Council: ` � *City Conncil Ward: -- -
*Preferred Mailing Address: ��l\�`1 i� S� ST �A�J� �1 r� Sslab '
*What is your occupation?
*Place of Employment:
Vcl.�vn12.� 1��2ec�o2 -
��
*Committee(s) Applied For: _
�
�1
�
*What skills, training or experience do you possess for the committee(s) for which you seek appointment?
C�`JTl�2 ��RC�- 2x���ev.cQ W�T� ��.8 Fvc�l�r�e5 Con,m,�tee�
� 7 ov � �un �- 2� �e e e c.Q Wc•2� ,,,� �n� T� � �� `� u V1� c\/.�.nn izn7iw5�
Qn� ti�o�� C1no� y- C1RL �v� 'cnT onC
' �, vUtL � p�{L L-l�dL»5�� `'� h\v nT 2� 2 ��T 5�� ll5 j 2�Qi2i cv�c.�2 V.h1R.1�� �-
� v.� c>i�.�e`�2��T��on �R�sTarLn �(t1.���iS w�Th id.� r1�2T� STe�2
(� �`
�US2.V �c 1'»� ��,T I NC,. � �<�`Z.,� S�a�1 t e r.G -
�`S b 5-�� ti'�'T� �X..��e..� 'R2SV�� .
\` ,
(over)
[Remember to Inclnde Telephone Area Codes]
o�/- 3i9
S � 2 ��2v�5 ��
. dress: ��Ja �6 Sc.�-e.� �cle �v"u� ST P/�1 � 1�'l YI J' S/( (�
Phone: (Home) � 5 t-�o �i�f - q`� � �i a �Vorkl
Name: Q�i c_���v n_� L L� t��a ��
Address: �J�l �-Pwsuh `I��� C� ST nn�/1� �'ln S51(��
Phone: (Homel b�t-'1`1\- `�1b�e�o �'orkl
Name: ���g-��o,r� �o4�nsoh
Address a�3C� � t��na,C� ST, S_ ST �V��� �� 11 �S ll `i
Phone: (Flomel �51 (Work) ��• �Si �{ (1'7
Reasons for your interest in this particular committee:� �,,,.� a�.,s�„ ,��,x,eS'r � n i l.as�
���.. nf�.r��-,T' \ v� � rv�c.p �n� 1 4��� n we T j hh � '� P�s2,2.A '��:,�
r���P�� � pr� �2 Pt� � c'C�.�s_ �wr.T c�� �.� C i
T�-T.av� y��:: �a�' p: eviae�s c�atac± with the committee for which you are making application? If so, when,
and the circumstances?
If special accommodations are needed, please specify:
�
How did you hear about this opening? 1��w� n�s � v- w��5 ,�