HomeMy WebLinkAboutCOUNCIL - AGENDA ITEM - 07/18/2000 - RESOLUTION 2000-92 MAKING APPOINTMENTS TO VARIOUS AGENDA ITEM SUMMARY ITEM NUMBER: 24
FORT COLLINS CITY COUNCIL DATE: July 18, 2000
STAFF: Wanda Kra}icek
SUBJECT:
Resolution 2000-92 Making Appointments to Various Boards and Commissions.
RECOMMENDATION:
Staff recommends adoption of the Resolution.
EXECUTIVE SUMMARY:
A vacancy currently exists on the Building Review Board due to the resignation of Rudy Hansch.
Councilmembers Kastein and Weitkunat reviewed the applications on file and are recommending
John McCoy to fill the vacancy with a term to begin immediately and set to expire on December 31,
2001.
Two vacancies also exist on the Community Development Block Grant Commission due to the
resignation of Holly Sample and the removal of Richard Rodarte due to UGA residency violations.
Applications were solicited and Councilmembers Bertschy and Wanner conducted interviews. The
Council interview team is recommending Tia Molander and Jennifer Molock to fill the vacancies
with terms to begin immediately and set to expire on December 31, 2001 and December 31, 2003
respectively.
A vacancy currently exists on the Electric Board due to the resignation of Joe DiRocco.
Councilmembers Masons and Wanner reviewed the applications on file and are recommending Guy
Helme to fill the vacancy with a term to begin immediately and set to expire on December 31,2003.
Two vacancies also exist on the Youth Advisory Board due to the resignations of Robin Horak and
Brian Fanning. Applications were solicited and Councilmembers Martinez and Kastein conducted
interviews. The Council interview team is recommending Aaron Steinbach and Robbie Weisser
to fill the vacancies with terms to begin immediately and set to expire on December 31, 2004.
A vacancy also exists on the Youth Advisory Board due to the resignation of Ki Shih (Team Fort
Collins appointee). Team Fort Collins is recommending Mera Geis to fill said vacancy with a term
to begin immediately and set to expire on December 31, 2002.
. RESOLUTION 2000-92
OF THE COUNCIL OF THE CITY OF FORT COLLINS
MAKING APPOINTMENTS TO VARIOUS BOARDS AND COMMISSIONS
WHEREAS, a vacancy exists on the Building Review Board due to the resignation of Rudy
Hansch; and
WHEREAS,two vacancies exist on the Community Development Block Grant Commission
due to the resignation of Holly Sample and due to the removal of Richard Rodarte due to a UGA
residency violation; and
WHEREAS, two vacancies exist on the Youth Advisory Board due to the resignations of
Robin Horak and Brian Fanning; and
WHEREAS,another vacancy also exists on the Youth Advisory Board due to the resignation
of Ku Shih (Team Fort Collins appointee).
WHEREAS, the City Council desires to make appointments to fill said vacancies.
NOW, THEREFORE, BE IT RESOLVED BY THE COUNCIL OF THE CITY OF FORT
COLLINS as follows:
Section 1. That the following named persons be, and hereby are, appointed as members
appointed as members of the boards and commissions hereinafter indicated, with terms to begin
immediately and to expire as set forth after each name:
NAME OF BOARD: Building Review Board
Name Expiration of Term
John McCoy December 31, 2001
NAME OF BOARD: Community Development Block Grant Commission
Name Expiration of Term
Tia Molander December 31, 2001
Jennifer Molock December 31, 2003
i
NAME OF BOARD: Electric Board
Name Expiration of Term
Guy Helme December 31, 2003
NAME OF BOARD: Youth Advisory Board
Name Expiration of Term
Aaron Steinbach December 31, 2004
Robbie Weisser December 31, 2004
Section 2. : That the following named person be,and hereby is,affirmed as a member of the
Youth Advisory Board,with a term to begin immediately and to expire as set forth after the name:
Mere Geis December 31, 2002
Passed and adopted at a regular meeting of the City Council held this 18th day of July,A.D.
2000.
Mayor
ATTEST:
City Clerk
4=ld-1999 12:33PM FROM OPTIMA MORTGAGE LLC 9702232856 p 4
Ku.
A ' A
QLYQLV Of
Applications received after April 14, 1999 will not be considered for current vacancies.Late applications will be flied for Putt re
vacancies.
Return completed application to:
City Clerk's Office •please type or use black ink
City Hall West •Please complete one application for each board or commission membership
P.O.Box S80 LaPorte Avenue .please limit attachments to two pages
P.O
Fort Collins,CO 80522 •For questions or additional information call the City Clerk's Office,416.25z5
FAX: (970)221-6295
Name of Board /� �.
or Commission: L L 11 IJ u/ tyt/t V
Name: �h yl -
Mailing Address: l9eo -S 7QS Tip gOs2(.
Residence: SA LAA d.
Day Phone: 970 a36•$�// Night Phone: 970 JVya_ Rr1< .)_
Years of residence Do you live within the Urban Growth Area?
in Fort Collins: � Btfes ❑ No(see attached map)
Which Council District do you live in? (sae attached map)
• Current Occupation:3Ren j g4t, s , Employer, _MCff
Prior work experience: (please include dates)
Volunteer Work: (please include dates)
Have you ever been convicted of a crime(except for minor traffic offenses that resulted only in a ine)? O Yes Nc If yes,please explain in complete detail. State the nature and approximate date of the conviction,the sent
whether the sentence has been completed,and any other information you consider to be relevant. ence imposed.
Are you presently serving on a city board or commission? ❑ Yes l(No
If so,which one?
Why do you want to become a mom er of this lieda tMt. �» Sathtm pbulab o f :on?
! jr �hj M o hdofl s T �_
4-14-1999 12:34PM FROM OPTIMA MORTGAGE LLC 9702232856 P. 5
Briefly explain what you believe are the three most important issues facing this board or commission, and how do you
believe this board or commission should address each issue?
,) 0 L
21 r e --
3)
List any abilities,skills,licenses,certificates,specialized training,or interests you have which are applicable to this board
or commission.
_�l1� (ft� .tcL [Ltettn.1 t•ON1Sf�rdG�tcN - c� ivtc r17�rr "It -
�e.tli.l DDrt�la rn f prero.cs . j�pert'o.rtc;L Aa efktr bM rds
JMMJM .f Cl Ad grind n{ !Kid
Please specify any activities which might create a serious conflict of interest if you should be appointed to this board or
commission: (if unsure call the City Attorneys Office at 221-6620)
Have you attended a meeting of the board or commission you are applying to or talked to anyone currently on the
board? O Yes (V No
Cornments:
All applicants are strongly encouraged to attend a regularly scheduled meeting of the board or commission for which
they are appl)ing. Frequent non-attendance may result in termination of the appointment
e
Signatu �� Date., _ •4S --
45 ;k APPLICATION FOR BOARD OR
MMISSION
Citvof Fort Collins • MEMBERSHIP
lications received after May24,2000will not be considered for current vacancies. Late applications will be filed for future
acancies.
Return completed application to:
City Clerk's Office -Please type or use black ink
City Hall West -Please complete one application for each board or commission membership
P.O LaPorte Avenue -Please limit attachments to two pages
P.O.Box 580 P 9
Fort Collins,CO 80522 •For questions or additional information call the City Clerk's Office,416-2525
FAX: (970)221-6295
Name of Board /� � � _
or Commission: � VIM (.)n I nT�{/�J_T L f� /yl /5 S�
4 .
Name: -rT(t.- `7 � ta` a L
Residence: I 0 ( e )oo l�7 Zip:��";�_j _
Mailing Address: q'50-4yve( Zip:
Day Phone: I�7 t f�0 Night Phone:
E-Mail Address: �f �� � �7Gi. (� I fIVLO . .eyy1
/ Do you live within the Urban Growth Area?
Years of Residence in Fort Collins: "7 Yes O No(see attached map)
Which Council District do you live in? (see attached map)
urrentOccupabon: NL�SI_CG Employer.
Prior work experience: (please include dates)
v fCb ' pre
� r _ 0 3
ram"
oCn c
Volunteer Work: (please include dates)
rne1(
Have you ever been convicted of a crime(except for minor traffic offenses that resulted only in a fine)? O Yes ,�<No
If yes, please explain in complete detail. State the nature and approximate date of the conviction,the sentence imposed,
whether the sentence has been completed,and any other information you consider to be relevant.
tWAre you presently serving on a City board or commission? ❑ Yes 'S,No
so,which one?
hy do you want to become a member of this particular board or commission?
a,f� c/ d
�✓ U i
Briefly explain what you believe are the three most important issues facing this board or commission,and how do you
believQ this board or com ion sh I ddra e9chissue?
e '
e _
2) 2 1 2 5 P �r
s
e q
v � fti
2 )l z
3) L v A/
r ) 1 i i r
List any abilities, skills, licenses, certificates, specialized training,or interests you have which are applicable to this
b—oatzrdo rcommission:Q. Y �j j
�Pa wo ��/l/� r ¢J
e a-�-2 G
Please specify an activities which might create a serious conflict of interest if you should be appointed to this board or
commission:
Have xou attended a meeting of the board or commission you are applying to or talked to anyone currently on the board?
a Yes' 'No
Com n
All applicants are strongly encouraged to attend a regularly scheduled meeting of the board or commission for which they
areapplying. Frequent non-attendance may resultin termination ofthe appointment.
Signature:
//-1' ��/C�� Date:
APPLICATION F • BOARD OR
COMMISSION MEMBERSHIP
ityof Fort Collins
pplications received after May24,2000will not be considered for current vacancies. Late applications will be filed for future
vacancies.
Return completed application to:
City Clerk's Office -Please type or use black ink
City Hall West -Please complete one application for each board or commission membership
300 LaPorte Avenue
P.O.Box 580 two,pages
-Please limit attachments to t a es
P.O
Fort Collins,CO 80522 -For questions or additional Information call the City Clerk's Office,416-2525
FAX: (970)221-6295
Name of Board
orCommissio11n: CamrinuniN Deye)oprrierd- 131oc.K riran+ cnmrnission
Name: fJPnni�Br W. Moloc,K.
effective
Residence: 's3 5 CzLrn i r)o Del M u nd o fv- 1 - oo Zip: 80 5z[H
Mailing Address: P Q. BoX x7Z-)a3 Zp: bosz -+
Day Phone: 491-51&1 Night Phone: -4$4- 31 2 j fo-I-oo
E-Mail address: __dr ienn yahoo.com
Do��ou live within the Urban Growth Area?
Years of Residence in Fort Collins: z E es ❑No(see attached map)
Which Council District do you live in? (see attached map) -i
Current occupation: Ad rn i n i 5+t kIr- Employer. Col Ora d o S-ha+e u r1 i V
Prior work experience: (please include dates) See Cl_b bre v i ocFed res a me aff'u the d
Volunteer Work: (please include dates) See oLbbr-ev tc+ed re sum o4+ct c hec4
Have you ever been convicted of a crime(except for minor traffic offenses that resulted only in a fine)? ❑Yes No
If yes, please explain in complete detail. State the nature and approximate date of the conviction,the sentence imposed,
whether the sentence has been completed,and any other information you consider to be relevant.
Are you presently serving on a City board or commission? ❑ Yes a_<0
If so,which one?
Why do you want to become a member of this particular board or commission? _E am Ir2 r i r A-_4.
s E2d
in learning how this C „cxrnisSior-, -GUnCfiOns clod -ft> be, obe+ e,-
A 5 0. ul+ 04: rry imyotye4reot.
Briefly explain what you believe are the three most important issues facing this board or commission,and ho:do ou.believe this board or commission should address each issue?
Ag" o pnces in 4tnis axe.o- litre- linni+ed heUiever" = bcIi, -I�cf-
-�i,P allcr•a+inn of funding could be be41e.- advertised -}a 4-he
corn rnu n itt Boo.rd rin a m o= a.r-�d o-I he+^s rn oLY i n a�uh l i c
npoe:rances a—iga aemer is -b all -&cats c-P 4he
z) More. e d call n i 'a WorKshops, serr-)f
O-ornmuni+.,t nrocarams -Gr- oay-income PerSn(1$
3)
List any abilities, skills, licenses,certificates,specialized training, or interests you have which are applicable to this
board or commission:
= am an excellerrl- public SpeoYer,enioy inkrac4iAo wi+h diverse 9rbgs of \
"gele. Hove a ill 'n earn haf ver N lCes be an efRcRVe
-r iris board
Please specify any activities which might create a serious conflict of interest if you should be appointed to this board or
commission:
nnn
Haye you attended a meeting of the board or commission you are applying to or talked to anyone currently on the board?
es 0 No
Comments: Cony rsai-inns wi+b Akfred Flares Sr
All applicants are strongly encouraged to attend a regularly scheduled meeting of the hoard or commission for which they
are applying. Frequent non-attendance may result in termination of the appointment.
Sig ature: Date: 6-23-00
-if Fort Collins - -
:pciicadons received after April 14, 1999 will not be considered for current vacancies.late applications will be filed for future
ac�ncies.
Return completed application to:
City Clerk's Office -Please type or use black ink
City Hall West - Please complete one application for each board or commission membership
P.O LaPorte Avenue -Please limit attachments to two pages
P.O.Box 580 P 9
Fort Collins,CO 80522 -For questions or additional information call the City Clerk's Office,416-2525
FAX: (970)221-6295
Name of Hoard <fl P A r-Le- .
cr Commission: cam'
Name: czv!� >,. 144 rn-t,
Mailing Address: 7-SO(. ��^� ^� C`r— 8 OS 2
_.� zip: S
Residence: �lmt.
Zip:
Day Phone: Night Phone: n e�
Years of residence 3 Do you live within the Urban Growth Area?
Fort Collins: )&Yes ❑No(see attached map)
ehich Council District do you rive in? (see attached map) a
Current Occupation: thnr♦t,mn, rS"Q02 ,&Say - Employer Vcluh;�2PZ m� vr�art^ �}Z S1Cp�
Priorwork experience: (please include dates)
Volunteer Work: (please include dates) (,V L w4
Qj
o G
Have you ever been convicted of a crime(except for minor traffic offenses that resulted only in a fine)? 0 Yes 'X No
If yes, please explain in complete detail. State the nature and approximate date of the conviction,the sentence imposed,
whether the sentence has been completed, and any other information you consider to be relevant.
a you presently serving on a city board or commission? O Yes )4 No
If so,which one?
Why do you want to become a member of this particular board or commission? W au,QO
r n a'c-D�e- ane LAMA(.� ,.. i 4: Saw�2 Ebe fcrw. .w Cl
Briefly explain what you believe are the three most importanth issues facing this board or commission,and how do you
believ this and or cam ion should address eac issue? r
i ¢t vtr rn L
i r
ti
z) �.PrP4u1r��w .� �a Tza Q �Se. rweva., h1irl_ J
I
's gre "yt 1 ,r. yr �-n C.w�_Ja�r✓ �. �wuntue
List any abilities, skills, licenses, certificates, specialized training,or interests you have which are applicable to this board
or commission:
Please specify any activities which might create a serious conflict of interest if you should be appointed to this board or
commission: (if unsure call the City Attorneys Office at 221.6520)
Have you attended a meeting of the board or commission you are applying to or talked to anyone currently on the
board? O Yes P!r No
Comments:
All applicants are strongly encouraged to attends regularly scheduled meeting of the board or commission for which
they are applying. Frequent non-attendance may result in termination of the appointment
Signature: !_��`�
¢0-E�/+ Date:
MAY-26-00 THU 13:13 CITY CLERK FAX H0. 07022L6296
VOUTH ADVISORY OARD
APPLICATION
a wa MAd tw twma
vi�nck�fccaneaavow abr+✓4 aoeawu na e.m�.dreelaeumMwcarar.tafesppl�fm a
Retain aarVisad gpaeadm te: ,.
aaY amwe otlW . rta.rtypwaaabls tink
City manWesr •Pleaae Broil dteoht+rda re bte PaYea
abd ltl to kmnua •FW*02dma 0r edddond wonrAthm
RC.am Sao aig am City etwVjs Ofte.416.25n
Catt Odahe.CO-w=
r,A>u (ero�O2t�5 -
laataw,tddAm - ZoCodr.lY�[.sa
Phonr. 7 _ q,o rw waver 21 yrn of yta: o+Pia ON*
E-Maa Address -e n fTA, Yn .
• w.ra draaidanea Cotlhs:_. WhWl C 00 OWbW de YOU km in?
f{Ly� ` pr.avw mrPl Cl
M you are a sn+aent,rAllrlt er},oddoyw ahead?.tS]ssrl(`e ` CwradGndelewr.=L_
IfYwhm&tab.wtwa doyW,vwI`h_aW*t*ooywdu7 FJ`�oe� At7i'c r • IIA(' ��T
PyW Oo ary voWrdetr wak wtwl kNddwork do You do atq wMn4•
Am ra+Praserdty aarviAg an a caY hoard dr fAtnmlasbn? o Ya �a
"go,which OW
Can)ou tarnmil to nmNinS one del a tmM far q ktot 1 yeart 04as 0Ho
y,�pyaueettbrgWandayowosatttanapoftaaoanuweor�0a? alb t]NO
It yw am wwor#m d21 ow atw in amook ham You di ul"yaw PwfiWPAho^on 00 boaN lft ym POW"
a puard'w(ak ltf`h. ON*
Have You ttwH bgttaawiunddatalme(aaoaW br nanarualfic ntfanaes d�ited�tlgawMCion.lM aeaMftca .
w rduwlN tontenoa Ipa aewt�dooapWed,attd afry dhet Ylglrttaflalt Ya,mralaerm G ralwlnt.
Z 'd E060-932-0L6 St O2 atrT =60 00 SO u^C
MAY•25.00 IV 13.11 CITY CLERK FAK Na 0791405 PI OZ/44
al�w��� a�w I�w mo>tit�l�uK(xiq�boat at oomn�onl�haw do KOu
„ T
m
&�. .
F }y1c 'na -ivy
- t
4 • .
reb14 in —
rciL
heT
3t Oan �`Q. �/ � 1 .�iit•Y1 r� n7Y1FR '11p_r C;� S
`„ � 6.4tc1 sl�1SLf„�• - .t Ah�l �4tt Ir_
LT ; ab,hfms,haw,r.W.M,a.Mb+s.. .eaoa Wti g or 6waaavou Mwaldch an applGWa b dsa Coald
areomn4ai.n:
PM"SWAY MV Agdvags rhkh a4M Clad.■",au,ooMid d wft"V YQY should be Appola to Om*ONG Of
camdatbn: (N unsYla allha Gy Atloln.Y'aClllu at 227•aalW
1 Yi7YU amM
bud7 O3% ugdUr hoodUNlnnllaalall Ydd La aODM°Y to Oft711p010 anYan.wmmtlY on M.
Conanants:
AN SoPliCAJO ya envau and p advw a gDd,*mhadll.ddraWg d dN bad or C mmolan al/W,40
�,y,s�„a palpWlndMl6t<I�a�Y»Sd/In temllwtlm+dMsa00ddm•^I• ..
SWARM
E 'd E060-99B-OL6 sia9 QbT :60 00 SO unr,
YOUTH • BOARD
APPLICATION
Ci of Fort Collins
lications received after May 22,2000wi1I not be considered for current vacancies. Late applications will be filed for future
ncies.
Return completed application to: y(
City Clerk's Office • Please type or use black ink
City Hall West • Please limit attachments to two pages
300 LaPorte Avenue • For questions or additional information
P.O.Box 580 call the City Clerk's Office,416-2525 JvAl
Fort Collins,CO 80522 1 `
FAX: (970)221-6295
Name: 9o1rA>z P
Mailing Address: (oCO C-aS Zip Code: s1=
Phone:(OLTc7 Are you under 21 years of age: Yes ❑ No
E-Mail Address: r n P�/ S �� (^off nw 1 •Gc n
Years of residence in Fort Collins: J q 11 ea rS Which Council District do you live in? 3
(see attached map)
If you are a student,which school do you attend? Pcrk to I( .v.5 Current Grade Level: A )
If you have a job, where do you work and what do you do?
If you do any volunteer work, what kind of work do you do and where? I vcl .v1 Ott d 0- - H�'p:ae OF
l� M4-r (OL-V\. F\ 1�( r•L� -Kip,- w:d'l. P..rd.-ei C., A- +1'i',vrA :t f'
(' i l lea
a�' Mw/ Cln,a.T/1ti� [,jtli5 �' 11v.:jr� Mu--M iLP Glw ('r.� r l^7.(PJi+c tt.l i,u:- �Nyi.Ngdtc�nj .
Are you Ypresently serving on a city board or commission? O Yes fd No
If so,which one?
Can you commit to meeting one day a month for at least 1 year? Yes t7 No
Will you be able to provide your own transportation to meetings? Z(Yes Q No
If you are under the age of 21 and still in school, have you discussed your participation on this board with your parent(s)
or guardian(s): gYes 0 No
Have you ever been convicted of a crime (except for minor traffic offenses that resulted only in a fine)? O Yes .21110
If yes, please explain in complete detail. State the nature and approximate date of the conviction,the sentence imposed,
whether the sentence has been completed, and any other information you consider to be relevant.
Briefly explain what you believe are the three most important issues facing this board or commission,and how do you ,
believe this board or commission should address each issue?
t) Sit 09 CtaAes ; 1 4'r 1 •kLt., c:,rre....* S �u o Se, AaI,
r 1 a sS?s 4 yP i6Yy..., do Lvwr ysou s l legit r`dye_, * %k— ;,.I 0 A,-r do !'lave
ov\.y rn�-ct �t Iy.i r w: V L- Itz r Yoe Sh..lrJ. 19z obit an hcvt
s nncJ..(_ r.l c,st Sr Kc 1ec ely r ro ma Ire sc� •e ez� a rx.w l do ewe
2) D� ctglan.t : .lZel -K-e r>✓.:sczp(lt (*v,- -eegm ju.n:ad', C"Zk hcs(I.� SU1noe(C
i S mm_-ex.;sl-a * . Wkt+k r i A ,asi' o. C.(as_5 A s-rc�ok r cr a cAcL o f
—�ro.v1�.2,.r'� oG:s��pl�� nnL�riutw-:!'I,� w.•ec.�s � 6n_ Mutt sel.'d. Wk.2v1 5:Jl; �2s:
oy'A ACI- re i U.i+ •t'toaA'M i d5 kc rA 44-
rANAA, cFn.�il�t.� do �a z av1cL4QC d.• -e- a�hete-
�t,V.�fOl5 sa, .
3) -eac4l,e5 L 1"ctl 30N%4- 4ea some scdux;ls hcut +tz P rscMe 2
Lq , CocV- L -4AAlL JtacGL s K,_I > da btu/ fttIle4k t� nunc.l a�uL n
ac urtL:0 d_S Snnar-be.+i sa.,5. 01 cCk tl&UA.a.blz. `r ln.:s 6carrl. r�2,e:�S dc� r`^a•�•2 sL,"—
w-
�`J� a1yM a t alwa�R raMnn. h cad�V . ;�1, s4 4,A , Wpix o 'd'xl.i A,,
ra.r� M.•w���n� C nnz C d++nLa T 1MaLGIS�•an r•� (/44 Lz-._nti &X_'L 4� C ri-}•w .c:� _
List any abilities,skills, licenses,certificates,specialized training,or interests you have which are applicable to this board
or commission:
CoMp kr51 ll,'' 1t1p:Lc-,kd,o, C[aris ukrl:S MrrrSoi l atd - A4-r .z+ k Erv.c,: l .
�;r-,rer5 t'ce,r•.se l havC ee-:,L �eacLusiti�pT�ea� c�.cl CoM"ti. �-cat�+'.;.` c•E.•lls
1rav-e ve �, yfl 'n1w<^1 k hzcenn•n< mr� v� :k nay rnnuwn•.4A ar-k cclael r
Please specify any activities which might create a serious conflict of interest if you should be appointed to this board or
commission: (if unsure call the City Attorney's Office at 221-6520)
Have you attended a meeting of the board or commission you are applying to or talked to anyone currently on the
board? 0 Yes p'No
Comments: 2 (3me�s vino r�rrs s11 4 vs�n � c�' 4tt 6 ^r,( M. cr.c el
�f�nl- -Pa no na•e �- �1n'r A.� l - Mht�:l '� (^`v rG rllZ
on JEsdt a
All applicants are strongly encouraged to attend a regularly scheduled meeting of the board or commission for which
''theyare applying. Frequent non-attendance may result in termination of the appointment.
Signature: �Li(�G� L/� Ypr7 Date:
L
YOUTH ADVISORY BOARD Vw/(
APPLICATION
• �rvtcousa,
WE: Application deadlines vary. Please check"Current Vacancy"listings for deadlines. Late applications will be filed for future
v ancies.
Return completed application to:
City Clerk's Office . Please type or use black ink
City Hall West
• Please limit attachments to two pages
300 LaPorte Avenue e.
P.O.Box 580 • For questions or additional information
Fort Collins,CO 80522 call the City Clerk's Office,416-2525
FAX: (970)221.6295
Name: 7
Mailing Address:)} yS_ w �V I e� 41 A3 1 ft I A) P- J r Zip Code: r Sz I
Phone: (J mo \o,l y 8 q- ys1 Are you under 21 years of age: 3 Yes ❑ No
E•Mail Address: Qd a STG 1 tl W a— 4!oMi;, ' Dr&
Years of residence in Fort Collins:-1 N AP-S Which Council District do you live in?
n (see atta5hed map)
If you are a student, which school do you attend? rA a r erz� SA-M6n z, Current Grade Level:
If you have a job,where do you work and what do you do? 1 ,)7,,AJ 7-� 1
F n r, r'r n t
If you do any volunteer work, what kind of work do you do and where?
Are you presently serving`on/�a City board or commission? ❑ Yes 9 No
If so,which one? � J/ A
Can you commit to meeting one day a month for at least 1 year? Jlk Yes O No
Will you be able to provide your own transportation to meetings? 19 Yes O No
If you are under the age of 21 and still in school, have you discussed your participation on this board with your parent(s)
or guardian(s): 9 Yes ❑No
Have you ever been convicted of a crime (except for minor traffic offenses that resulted only in a fine)? ❑Yes Z No
If yes, please explain in complete detail. State the nature and approximate date of the conviction,the sentence imposed,
whether the sentence has been completed, and any other information you consider to be relevant.
Briefly explain what you believe are the three most important issues facing the Youth Advisory Board, and how do you
believe�the board or commission should address each issue?
,) Ha141 e 1416 AP1;,N-T) FP PINJA5, ti F20162 rR 15 703Al711n
<6-r-r,6 Mc,u 17
I It LICvf wB 5NiVZ- r HAvZ; /7 OAA,'A,'9Z, F/r2 SACµ 14164
ao - P-
O N AN S 44
PAN THE gr4e 2V li Y A" 60e—D I A.).r,j 11.
z) / -13fi L ► FI/f. I%fjZ 72 L//2 A7 11112 d I0)126 /0
_gym ti f w�i f P2�i3i_1,-;o4,5 a I i 7;V a1 //0 4U.e
�t(,lfnDl S,
3)
list any abilities, skills, licenses, certificates, specialized training, or interests you have which are applicable to this
board:
To QPrf �fE
Please specify any activities which might create a serious conflict of interest if you should be appointed to this board:
Awl arr v�Qv Allan tj 1A) SnCGbt2 . I 'nn u�r en, A ri>APl
T Pe eel?-14 a U r rP! A is fr.
Have you attended a meeting of the board or talked to anyone currently on the board? ❑Yes a No
Comments: 01,4
Mapplicants are strongly encouraged to attenda reguladyscheduladmeebngof the Youth Advisory Board.. Frequent
non-attendance may resultin termination of the appointment
Date:
Signature: