1

Vacancy for the Advisory Body(ies) you are applying for: 

 *

Vacancy for the Advisory Body(ies) you are applying for:

Arts Committee	Housing Advisory Commission	Policing Commission
Climate Action Committee	Parks, Recreation & Open Space Commission	Racial Inclusivity & Social Equity Commission
Financial Advisory Committee	Planning & Zoning Commission	Transportation Commission

2

Personal Information:

 *

Personal Information:

Name (Last, First)

Home Address

Telephone

Preferred Email

Occupation

Business Address (Optional)

Work Phone (Optional)ext.

3

Please state why you are interested to serve on the Advisory Body for which you are applying?

Please state why you are interested to serve on the Advisory Body for which you are applying?

4

Please state your qualifications for this Advisory Body and your objectives if you become a member:

Please state your qualifications for this Advisory Body and your objectives if you become a member:

5

Please list past and present community activities you have participated in:

Please list past and present community activities you have participated in:

6

Are you applying for the high school student member seat or the adult member seat affiliated with students within the City of Albany?

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Are you applying for the high school student member seat or the adult member seat affiliated with students within the City of Albany?

Yes (Please answer Question #7 or #8 as applicable, and continue to Questions #9 and #10)

No (Please skip to Question #9)

7

If you are applying for the high school student member seat, please state the school you are attending and your current grade level.

If you are applying for the high school student member seat, please state the school you are attending and your current grade level.

School:

Grade:

8

If you are applying for the adult member seat affiliated with students within the City of Albany, please state how you are affiliated.

If you are applying for the adult member seat affiliated with students within the City of Albany, please state how you are affiliated.

9

Is there anything else you would like to share that is not covered in this application?

Is there anything else you would like to share that is not covered in this application?

10

By checking this box you attest that the above information is true and correct and you acknowledge that information submitted to the City of Albany may be subject to disclosure per Public Records Act:

 *

Yes, the information above is true & correct.

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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