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93-65 �tt� �'� � Council File # �� Green Sheet # �� 1 �� RESOLUTION CITY OF SAINT L, MINNESOTA ,� .. Presented By Referred To Committee: Date RESOLVED, that the Saint Paul City Council consents to and approves of the reappointments and appointments of the following people to serve on the ADVISORY COMMITTEE ON AGING. Reappointments Term Expirinq Marvin Grunke November 30, 199� Hortense Quesada November 30, 1994 Eunice Green November 30, 1994 Appointments Nancy Adair . November 30, 1994 Joan Wittman � November 30, 1994 Frances Hart November 30, 1994 Pat Schwietz November 30, 1994 Katherine Barron November 30, 1994. Yeas Navs Absent r�— u e�riri � �— on��— �`— Requested by Department of: acM cabee / e�man �` ufiF ne � i(t'Tson ,— �i BY� Adopted by Council: Date �AN�, 8 199� —�L Form ve y C' y orney � Adoption C "�' d by Coup i� Secretary By: � _�� ,� By: �� Approved by Mayor for Sub ission to Appr ve by �yflyo : Date t � G(� Council !✓�a��-�i,�-��`G By: By' _ �. �� FE� � '93 k�yl+ �a9J,�r:I �� 93_�5 ✓ Mayor� s of�ice, 29s-4323 �1/�.�/92 �REEN`SHEET N°_ 22495 a �m�uanre �N�ruvo�re oFwi�rMerrr�RECr� �cm c�ca Mary WheeYer=Baker �ss�on m�„�awe,r �cmra�R+c er�o�►� �� euooEr a�croR Ru�.a Mar.sEnv�s aR.. � �� w►voR coa nssisr�m p TOTAL#E OF SIGNIITURE RAaE8 (CUP ALL LOCA,TIONS FOR$IONATURH) . ACTION REWESTED: Reappointments and Appointments to the ADVISORY COMMITTEE ON AGING REOOI�AENDATIONS:Approw(A)a Rs�sCt(R) pER80NAl SERVICE CONTRACT'S M�T ANSMIER THE FOLLOWINO CUES170N8: _Purarn�6 cOMM�ssroN _c�sEmnce co�� . Has ads personmrm e�wwksd u�.r e cx�mect tor tMS deperanent4 _CIB f�hiMITTEE _ �S NO 2. Mas thfs psreonlfinn e�rer bean a cNy empioyee? —�AFF — YE3 NO _o�sTi+icr ca,Rr — a. �oes tnie psreorUfirm possssa a skiu na nonnaNy poessetsd br enr a,rrent cny employes? SUPPORTB WHK:t1(�U1�Il OB,IECTIVE7 YES NO E:platn sll ya enswers on s�►at�sM�t and etqiah to�n�n sM�t n�rru►ra�c3 r�e��.issue�OPPORTUNITY lWho.wn.e.vim�,w�..wnr�: None. : RECG��►�E� JAN �1 1993 CiTY ATT0�6�� ADVANTA(iE8 IF APPROVED: Reappointments and Appointments to the Advisory Committee on Aging. See � attached Council Resolution for names and expiration dates. D18ADVANTAOES IF APPROVED: RECE{VED JAN 14 1993 CITY CLERK D18ADMANTAOE8IF NOT APPROVED: � �SEBfCIt C�t� JAN 1 ;R 1993 TOTAL ANFOUNT OF TRANSACTION i COST/REVENUE QUDOETEp(CIRC�E ONE) Y88 NO FUNDINO SOURCE ACTIVITY NUMBER ��N�MA�:«,►�> dw NOTE: COMPLETE DIRECTIONS ARE INCLUDED IN THE OREEN$HEET IN3TRUCTIONAL � MANUAL AVAILABLE IN TkE PURCHA3INQ�FFIG"�(�HbNE NO.298-4225). ROUTIN(3 ORDER: Below are correct routlngs for the five most hequent types of documents: CONTRACTS(assumes autho�ized budget exiats) COUNCIL RfSOLUTiON(Amend Budgsts/Accspt.Orants) 1. Outside AQency 1. Department Director 2. Dspartmsnt Director 2. City Attorney 3. Ciry Attorney 3. Budget Dfrector 4. Mayor(for contracts over 575,000) 4. MayodAssistant 5. Human Rights(for contrects o�rer$50,000) 5. Ciy Councfl 8. Finance and Mana�ement Services Director 8. Chief Ac.countant, Finance and Managemont Servlcea 7. Finance Accountlng ADMINISTRATIVE ORDERS(Budyet Revisbn) COUNCIL RESOLUTION(all others,and Ordfnancea) 1. Actf�rity Manager 1. Department Director 2. Depertment Accountant 2. City Attorney 3. Dspartment Director 3. Mayor Assistent 4. Budpet Director 4. City Council . 5. Ciry Clerk 6. Chief AcxountaM, Finance and Management Servioes ADMINISTRATIVE ORDERS(all others) 1. Department Di►ector 2. Ciy Attorney 3. Finance and Management Services Director 4. City Clerk TOTAL NUMBER OF SICiNATURE PA(3ES Indieate the�of pages on which signatures are required and pap�nclip or flaq pch of tMt�ppu. ACTION REOUESTED Describe what the project/requsst seeks to axomplish in either chronologi- cal orcler or order of importanc�whichever ia most appropriate for the issue.Do not wtke c�mplete Sentar�ces.Begin eech Rem in your list with a verb. RECOMMENDATIONS Complete if the issue in question has been presented before any body,public or pNvate. SUPPORTS WHiCH COUNCIL OBJECTIVE? Indicate which Councll objective(s)your project/request supports by Iisdng the key word(s)(HOUSIN(�,RECREATION, NEIOHBORHOODS, ECONOMiC DEVELOPMENT, BUD(�ET,SEWER SEPARATION).(SEE COMPLETE LIST IN INSTRUCTIONAL MANUAL.) PERSONAL SERVICE CONTRACTS: Thie information will be used to determine the city's liabiliry for workere compensation claims,taxes and proper civil service hiring rulee. INITIATIN(3 PROBLEM, ISSUE,OPPORTUNITY Explain the sRuation or conditions that created a need for your project or request ADVANTAGES IF APPROVED Indicate wheMer this is simpy an annual budget pr�cedure required by Iaw/ charter or whether there are speciflc ways in which the City of Saint Paul and its citizens will benefit from this project/action. DISADVANTAQES IF APPROVED What negative effects or major changes to existing or past pra;esses might this projecUrequest produce if it is passed(e.g.,traffic deleys,noise, tax increases or asssssments)?To Whom?Whe�?For how long? DISADVANTAC3ES IF NOT APPROVED What will be the negadve consequenc�s if the promised action is not approved?Inability to deliver service?Corttinued high traffic, noise, acxident rate?Loss of revenue? FINANCIAL IMPACT Although you must tailor the information you provide here to the issue yoy are,addressing,in general you must ansMrer two questions:How much is it going to cost?Who is going to pay? L'�3-�� Interdepartmental Memorandum CITY OF SAINT PAUL To: council President William Wilson Councilmember Janice Rettman Councilmember Paula Maccabee ��c��u�i� � Councilmember Dave Thune councilmember Marie Grimm ,jNN �. 4 199� Councilmember Bob Lonq councilmember Dino Guerin ��TY �;L�� FROM: Mary Wheeler- ker '� Jean Karpe ��,� DATE: January 4, 1993 RE: Reappointments and Appointments to the ADVISORY COMMITTEE ON AGING Attached is a Council Resolution recommending the Mayor's reappointments and appointments to the Advisory Committee on Aging. Reappointments Term Expirinq Marvin Grunke November 30, 1994 Hortense Quesada November 30, 1994 Eunice Green November 30, 1994 Appointments Term Expirinq Nancy Adair November 30, 1994 Joan Wittman November 30, 1994 Frances Hart November 30, 1994 Pat Schwietz November 30, 1994 Katherine Barron November 30, 1994 Attached are copies of the applications from: Nancy Adair, Joan Wittman, Frances Hart, Pat Schwietz and Barbara Anne Rode. Please feel free to call me if you have any questions. MWB/j rk Attachments � . • OFFICE OF THE MAYOR - ��'�y� . 347 CITY HALL � �.�'.'`'e�s'" SAINT PAIIL, MINNESOTA 55102 298-47 6 �LT 2 % �JJZ �// � � a. .,1��4�n NSTQe. � � lli:�i'� C'"'rx.+, ��) �:,M �i: � Home Address: � � � � � _ �r�`"/�� Street City Zip Telephone Number: Home � � � � Work (P c"/ ' �� Planning District Council: _� Ci�y Council Ward: Preferred Hailing Address: � _ � � What is yovr occupation? d �/�f �Q G� Place of Employment: � Committee(s) Applied For: � �f � � ' / What skills/training or ezperience do you possess for the committee(s) for which you seek appointment? l/ /V C (f � - � � . � �� . (/ / _ � The information included in this application is considered private data according to the Hinnesota Goverment Data Practices Act. As a result, this information is not released to the general public. (0�) Rev. 8-15-90 : �i��f-iL��1i PERSOPIAL REFERENCES ` ' / f _L�G�/�1� . Name• �� ` /r�° �� 7C�2� . . � Address: �� ->'7�C l/7 , �� (,T��/�. Phone: (Home) (Work) ��- �� Name: �"V C `��n�J ,�� i �l l/� ��/�7��"1� � � � J��,3l0 Address• ` u G�/ G - �(,G� Phone• Home TTork (, �— Name: / �t l � � �--- G � Address• / �� ' / , � Phone: (Home) (Work) / q �� c (��7 Reasons for your interest in this particular committee: /� U � U� -� j� � C � °v�. > > � C � ` . - Have you had previous contact vith the committee for which pou are making application. If so, when, and circumstances? / � � . In an attempt to ensure that co�ittee representation reflects the makeup of our community, please check the line applicable to you. This information is strictly voluntary. White (Caucasian) Hispanic Black ican American) Asian or Pacific Islander �iican Indian r Alaskan Eski.mo Male � f � Eemale Date of Birth: � �• <� � � / Disabled: Yes No � If special acco�odations are needed, please specify. � How did you hear about this opening? C..L/� � . �1 ;';°v i �'j 1� ( OFFICE OF THE MAYOR - '""' ��Y�" , ` �� ^� � 347 CITY HALL � Sr�l `_ SAINT PAIIL, MINNESOTA 55102 Q�T � 6 ��` 298-4736 Na.me: Joan Wittman ir';�'i'v:='� �a'�'sv� Home Address: 1498 Fremont Ave. St. Paul, MN 55105-5420 Street City Zip Telephone Number: _ (Home) 774-4008 (�Tork) same Planning District Council: 1 City Council Ward• � Preferred Mailing Address: 1498 Fremont Ave. St. Paul, 55106-5420 What is your occupation? Parent Educator Place of Employment: _ Working Parent Resource Center, St. Paul Public Schools Community Ed Committee(s) Applied For: Committee on Aging � ��f,t/� What skills/training or egperience do you possess for the committee(s) for which you seek appointment? Professionally, over the last 25 years, I've coordinated adult programs and taught adult enrichment. My post-graduate training has included knowledge of adult life stages and learning styles. In 1987, I was granEed�.Minnesota Parent Educator license and have been working with St. Paul Public Schools, Early Childhood & Family Education program. _ � Three years ago, the Director of the Working Parent Resource Program, knowing my interest in aging encouraged me to develop a curriuclum for care-givers of aging persons. Througr my own personal experience, research and classes on aging, I have developed a curriculum and am offerin it as a noon-time seminar at various work sites. The skills I bring include; knowledge of aging, facilitating adult groups, and am told, attentive listening skills. I also, have servedon many committees and believe in the collaborative approach. The information included in this application is considered private data according to the Hinnesota Goverment Data Practices Act. As a result, this information is not released to the general public. Co�t) Rev. 8-15-90 PERSONAL REFERENCES • Name: Marcie Brooke, Director of Working Parent Resource Center . Address• NCL, 445 Minnesota St. , Suite 520 Phone: (Home) (Work) 293-5330 Name: Cheryl Meyers Address: 2186 Waukon St. Paul, 55119 Phone: (Home) 739-9062 �tiTork) 626-5170 Name: Howard Young Address• 6 �7. St. Albans, Hopkins Phone: (Home) 938-6209 ____ _ (Work) Reasons for your interest in this particular committee: 20 years ago, over a 5-year span of time, both my parents and father-in-law, suffered major health and dependency problems. At the time my children ranged in age from 14 to 5, I was working part-time and there were no community services available to us. As I am approaching that phase of my own life, I want to address aging issues however I can. Have you had previous contact with the committee for which you are making application. If so, when, and circumstances7 " NO In an attempt to ensure that committee representation reflects the makeup of ot�r community, please check the line applicable to you. This information is strictly volwntary. �_ White (Caucasian) Hispanic Black (African American) Asian or Pacific Islander American Zndian or Alaskan Eskimo Male X Female Date of Birth: 2/23/31 Disabled: Yes No X If special accommodations are needed, please specify. How did you hear about this opening? Through the Senior Federation newsletter . � � I�� OFFICE OF THE MAYOR � ��" `�"� �-`'--`--•-- r , 347 CITY HALL ' SAINT PAIIL, MINNESOTA 55102 S-� " ' - ' 298-4736 `` � � Name: _ PA� S-/l (,v��Z °'. • . .-..,_ �; ., Home Addre s s: ��/�'� �dl,e�j�E/� �i4r� .S�'- �R G�li i�n S// � Street City Zip Telephone Number: _ (Home) �3G- 7 S t� / (pork) � � �- �� cf�/ Planning District Council: �/Si�iGT / City Council Aard: � Preferred ?Sailing Address: /_c/�/ ��-/�.��/� �-h� What is your occupation? C..��c�r_ ��r�►�'P.Pr �PV✓ict� S Place of Employment: _S7= �vSe.(�h r �L'�5�7 _ � �. . � '; Committee(s) Applied For: �r,�„� ,y`�,-�.> r,�., ��n� j``.�� -r�� What skills/training or egperience do you possess for the committee(s) for which you seek appointment? � �U f . L"�OU fl�t�, O � . O e'_✓ c?• �i�C c°S T. � 7 ��5 ST. > — C/c�/v�,ft�- �fn �oecl.9LV7`2 j�o�/�i C F -- - - S� .� , � ,�c S� � J � � � -�7g /� � .� d2-�e�/y• ✓ �//�/el�1 �.1��— '7LC'_!/ l�vSi c> OsyiP /7r'1 C�4-I� • �/GGn�u'J A4.c�_ � . S �� , Glf I ' �t`?aGr1 "� -- . �GG6�TC — /�TC C.d c�,-�� ' C. 7�c7 Cz�,�r�u� y--/o•� 5 -_> `i�P Snh�f'��-/�� C� �r�c�P/� � . y7 S F�h/��/T ��1�1�f�,P �C>C/�/�S ��' � L C/J�72«s -- 17�c'c/ cv��i �r��a�.�C9.��v.�/J �h.4c��P ,�'�>c.. A Sir� _ �r �/��f'��1�' ��T Si��c�vJ /3E /fi�/>.Z�—SS�-� / / ' �- �7�-t/P �'r�t>l'i �i'I.4� O �I�-� / /c,1A�r7 i� v�t.�J,-,�.P1•�t.C9 S�� s-�-i�/ f�'�h /�S�i� -�-z/ �� ` r �q-fL� f�«' �i�i`c��v� c _ ��f a?,G �G'CJL/� JSE'.rli�77 CC/ �E NL ) IC� C) ?� � The information included in this application is considered private data according to the Minnesota Goverment Data Practices Act. As a result, this information is not released to the general public. �0�� Rev. 8-15-90 ��-U�s ri-a 9i--' PERSONAL REFF�tENCES Name• -_ � `"��,�c°c�r� � � O� �2/�J�� ' , •-, � Address• L�� !/v � C° XCi�7hZi'l�i� • Phone: (Home) � .3 S—>3 �� cQork� �� a — 3 �—� 7 /��r�s /-//2«�"02 0� ��e. ��2d�c_ ,� � S?- .%>• /`/o s� Name: ��Z�� ,P Address: �.� � /�C�� -- X��9-�1�i 'C • -� o Phone: (Home) (tiTork) � � Z - �3 3�f ;y�� E � � Name• � ' � � ' �- U O � Address: ��• �� t-�� Phone: (Home) FZL�- '�!_ �� (�Jork) �� - c�/ 2_ S Reasons for your interest in this particular committee: � f e e/ �f�- ?� e��z �c �,L��i , �e e� Y� ��-ci � �� o<{, /L—� ,�-�� r> >�i f �� `i A �� — /t/i �� ;�<k C��af/1�� g-�oe .4 /-P ��n ��' d�d t�`` �r'TGJr.�'¢�'E" � �.� � G�i4��y..�� S /�h� �?��L/��=�z c ca �i��i�� lo cL-P G.�� --�r�r°��cA/ �.��Jh %C-xT � Have you had previous contact with the committee for which you are making application. If so, when, and circumstances7 �v • In an attempt to ensure that committee representation reflects the makeup of ou.r community, please check the line applicable to you. This information is strictly voluntary. !J White (Caucasian) Hispanic Black (African American) Asian or Pacific Islander American Indian or Alaskan Eskimo I�a.le , � Female Date of Birth: r� -3 Disabled: Yes No � � If special accommodations are needed, please specify. Hov did you hear about this opening? � //2/ dA�L.�'J �L°,�.e{ !' .P_� . ��E��/�G /�y/�G-�Z�E� GtJ� � �Os'1� �� 1 r� I=C�!I�i��'�- , � I � � OFFICE OF �,;':=" '�` `1� " "j� THE MAYOR ��w_ ��I�.�� ^�Q�. 347 CITY �iALL . � SAINT PAIIL, MINNESOTA 55102 OCT 1 � 1S91 . 298-4736 Name: Nancy Adair �':`� ..�,'� :arfii�� Home Address: 2136 West Hoyt St. Paul; Mirmesota 55108 Street City Zip Telephone Number: _ (Home) ��9810 ��ork� 641-0869 Planning District Cotmcil: 1� City Council Aard: 4 Preferred Mailing Address• Same what is yovr occupation? Che�nical Dependency crnmselor in private practice Place of Employment: __ My office is at 3523 Hemzepin Ave. So in Mpls. Committee(s) Applied For: __ Advisory Comnittee an Aging Ahat skills/trai.ning or ezperience do you possess £or the committee(s) for vhich you seek appointment? I bring to this comnittee my lmowledge of chemical dependency. I ha.ve becorne inter- ested in the special needs of the elderly with regard to chemical dependency assess- ment, interventian and treatment. A research paper I prepared for a class last winter revealed both the need for treatment for older people and the reluctance -famil� and health ca.re workers have with suggesting ch�nical dependency trea.tment I am a student by nature and. ha.ve been educating myself about aging by taking classes at the imiversity as well as atterxling lectures and reading. I am presently facilitating a women's program to encaurage dialogue between elderwomen and younger women at Joyce Church in Mpls. Thirdly, I am interested in aging from a persanal viewpoint. I am close to 60 years old arxl. I am interested in making the last third of my life joyful and exciting. I can't think of a better use of my time than serving on an aging committee with others interested in similar goals. As a woman I also bring my interest and membership in all-women groups such as Melpfiene and Midlife. The i.nformation included in this application is considered private data according to the Minnesota Goverment Data Practices Act. As a result, this information is not released to the general public. Co�t) Rev. 8-15-90 PERSONAL REFERENCES Name• � Meissner Ph.D , Addres�+2 Stmmit St. Paul, ML�1 Phone: (Home) 222-1471 (Work) 644-2267 Name- JoBeth Marsha.l Institute of Chemical Dependency Professianals Address:___596 South Osceola St. Paul, M[�1 Phone:__ (Home) (tiTork) 227-7584 Name: Barbara York Address: 3319 Emerson South N1pls. , Mb1 Phone:_ _ CHome) 825-2699 (Work: saz:� Reasons for your interest in this particular committee: _ I ha.ve some time available since I have ma.de the decisian to work part- ti.me arid I want to give something back to my cocmn.mity. other interests for my volunteer time are the ethics committe of ICDP and m local Co-op. I am very interested in the aging issues right now and believe I ca.n ootn conLriuute ar� continue to learn. Have pou had previous contact with the committee for vhich you are making application. If so, when, and circumstances? NO In an attempt to ensure that committee representation reflects the makeup of our community, please check the line applicable to you. This information is strictly volvntary. X White (Caucasian) Hispanic Black (African American) Asian or Pacific Islander American Indian or Alaskan Eskimo Ma.le x Female Date of Birth: 12/29/34 Disabled: Yes No X If special accommodations are needed, please specify. How did you hear about this opening? Habitate For Htmianity / Senior Federation � � _..:_-� _ � OFFICE OF THE MAYOR Q 347 CITY �iALL ��r.�r r - -:- � f� �`'' � �"��.v\ SAINT PAIIL, MINNESOTA 55102 �,`_�`� ; � , � � " 298-4736 ) ,� �3,�r�R� � .. � � � .-. .��_ Name: /l T}��JJd� ��fJ-�l� N Home Address: �07 7� �D ,�7��l DI� J T �T�f�l�L �I�1/11��50 1� 5�—/B/ Street City Zip Telephone Number: (Home) 77` `U 77 (`Tork) Planning District Coimcil: � City Council Aard: .� Preferred Hailing Address: �027� �� T � What is your occupation? 2� �'/RC� �D C lft.L. {t1�B�IC�Q Place of Employment: ,�% Tf�l/•L �U�1/C ,��s,�r4 �G�N e V Committee(s) Applied For: �d ��SD�V I�MM 1 TTF� D/� �.�i�//Il� What skills/training or ezperience do you possess for the committee�s) for which you seek appointment? ,r 1-�A�� LUB R1�C�D }S �}lV D,�,Fif�l1 z E/2 /�J�1� ��'DG'/•9� I�1�2/L�2 ._..1� l�'� �T�i �h� ('.��v r��-G�'�! �Es' i u ��l� f/l�=A-. � AM C'E/��l�NC7 D�t1 ,�f � Rb� � !t/ICf��1N��,� �D�2 ��I�EI� �C�"ir�i� �ieD�l�A��S .Q�1,� /�-A-VF ,!'�'i2 Y�D Dl�l T�f��' �Df�/2� ��11 T�f� �fl S'T T92 �'�l � �l�ST �0 �F�}-�2S D� �Nl�,td y NlEhT l!/� Ttf- }�f.tBLi � � S /N 6 � M�T !�/Z T1�- �4-��1.I C��l TS �6/L �uS�,+!�i z�t. �'t��- i1Z �NIF S , T�-1 �S �//�S BY�2 �'�1� N/E �i?o �D.�i �'��u ��'� iN �� 1+�R�4� l��/,C lU T1�S 1� �' �Gf/Z PaS'� m�- T�� NI E/_ �/�v��' �i!f�S' � �ll,�� A-r� i��M �e I2 �,8/L��/ �D .�l ✓� �IV,D��DCNJ��N 3Z y /N �I� }��f�12�'NI�JV i ��/.S ��F,�l ��►lllm� 1/FD j�� ►=�12�/�-LS 1 0 .�C��IUI�,�S �D72 S�D�UICYS I��D .,�ND /� �'9�F L�AS�S ��'3'A�B�-lSN/N�i f}- ��'O�ISB� �-Q�. �� ,Ll L��/T �l�mM >�� 1S1 i f�Vd � V�/LR�.�,LE J.�l�O�tVI�}-��N � /.UdGC�.D ,F��'t/�L D� f�- 2� �DRt� �N l�f��/d� T� �4 Y��B V� 6��2 �N y �� ,!��-1 L��0� • The information included in this application is considered private data according to the ?iinnesota Goverment Data Practices Act. As a result, this information is not released to the general public. //S,f,�s�-�� (D r ,��E r�,��ca o�r ��- ft �N GG�'a�� /d�l Rev. 8-15-90 f��e v ,� o� y u� �,�NN/�Y4 ��NC'/L �N u��x �ESmu�C�'S D� {��J TD� Cd/y�1�A!!i t� �h�VlC� ,�O��D ��'G PERSONAL REFERENCES : �. S Name• /'1/�-R� J �u 8 F�. Address: �D(0 T4��/N� Phone: _ (Home) ��0 '.�.� � � CWork) a� " .�'�� Name: Address: �� ! 2.! C l A �� N 1�S Phone: (Home) ..��7 � �/�6 [tiTork) a a � � �'a�� Name:_ �,D � T� �,�} ,Z L 1�/Z Address- /7/6 � � lyl�4 ��C R l�l� ,�1/� Phone:_ _ (Home) ��- � �a 9 (i�Tork) Reasons for your interest in this particular committee: �_/}NI JN %r�FSTED /N A �L- ISSIIE'S D� C�d�/II��I�! ?"p �LOf�Ly C 1 �"/ Z �N S A�� 1� �A-u L� .I h��9 4/� V�!�R �D �!J! T.4 l�1 C'�1,� I2!�� .s'i��N rs T� D 2�,s,v i z� �ou n� � ��S �v D �s f o�� r,�B k��- �a �� S��v 1�� v s �0 1��,r� >�va��nr �N ��y . I ��+ v� ��l�%�d N1 A N y cSOD,� �X �R1E�V CrS W t� I C f',�l�f,C,D ,�� S'�F6!� � T� �'�' �' Have you had previous contact vith the committee for which you are making application. pJ�fz'�� If so, when, and circumstances? l�o In an attempt to ensure that committee representation reflects the makeup of our co�unity, please check the line applicable to you. This information is strictiv voluntary. ✓ White (Caucasian) Hispanic Black (African American) Asian or Pacific Islander American Indian or Alaskan Eski_mo Hale �_ Female Date of Birth: �� /� �� Disabled: Yes No ✓ If special acco�odations are needed, please specify. �3ow did you hear about this opening? �� /(OF LLC� �►- �L �EN ��i �X.