Committee / Commission Participant Application Form
Please fill out the below application for the committee/commission you are interested in joining. The Central Coast Regional District thanks you for your involvement in our community and will contact you shortly.
Your name, contact information, and electoral area are required to apply. Any additional information is helpful for consideration but not mandatory for your application.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Do you identify as First Nations?
Yes
No
Which Electoral Area do you reside in?
*
Electoral Area A (Ocean Falls-Denny Island-Wuikinuxv/Rivers Inlet).
Electoral Area B (Bella Bella).
Electoral Area C (Precipice-Stuie-Firvale-Saloompt-Hagensborg to Ausgburg Church).
Electoral Area D (Hagensborg past Augsburg Church-Tatsquan Creek- Four Mile Reserve-Townsite Reserve).
Electoral Area E (Bella Coola Townsite).
If Yes, what First Nations do you identify with?
Which Committee/Commission are you applying for?
*
Please Select
Hagensborg Water Services Advisory Committee
Accessibility Committee
Centennial Pool Advisory Committee
What target group(s) do you represent?
A person with a visible or invisible disability; including physical, cognitive, perceptual, and/or mental health disabilities.
A member of a disability-serving organization.
A parent or guardian supporting someone with a disability.
A person with Indigenous background.
A person from another equity-deserving group.
Please describe yourself and your involvement in the community.
What is your experience serving on a Committee, Commission, or Board?
Why would you be a good fit as a member of this Committee/Commission?
What is your vision for this Committee/Commission? How would you like to see this Committee/Commission benefit the community?
Can you commit to meeting (virtually or in-person) a minimum of once every 3 months?
Yes.
No.
Maybe - depending on meeting times.
Submit
Should be Empty: