Application for Student Commissions

Application for Student Commissions
City of Sierra Madre
232 W. Sierra Madre Blvd. Sierra Madre, CA 91024 626.355.7135

www.sierramadreca.gov

Submit completed application and two reference letters.
PERSONAL INFORMATION
NAME (First, Last)*
DATE*

MonthDayYear
Date
CITY OF RESIDENCE*
AGE*
COMMISSION
COMMISSION/BOARD/COMMITTEE FOR WHICH YOU ARE APPLYING*
Why are you interested in serving as a member of this commission?*
What specific attitudes, skills, and expertise do you think you have to enhance the work of the commission?*
SERVICE HISTORY Are you currently volunteering anywhere?*

YesNo
NAME OF ORGANIZATION
DATES OF SERVICE

MonthDayYear
Date
NAME OF ORGANIZATION
DATES OF SERVICE

MonthDayYear
Date
You are invited to attach additional information or submit supplemental information which you feel may assist the City Council in its evaluation. Supplemental information is subject to disclosure under the Public Records Act.
PERSONAL INFORMATION
NAME (First, Last)*
DATE*

MonthDayYear
Date
ADDRESS*
CITY*
STATE*
ZIP CODE*
HOME PHONE
MOBILE PHONE*
EMAIL ADDRESS*
example@example.com
BACKGROUND
HIGH SCHOOL
CITY
COLLEGE
CITY
GRADE/CLASS YEAR
MAJOR
COMMUNITY ORGANIZATIONS (e.g. Rotary Club, High School Clubs/Organizations)
INFORMATION ON THE PROCEDURE

The Commission or Board will review all applications and may appoint a non-voting Student Commissioner to serve a one-year term. Two reference letters must accompany the student’s application.
FULL / UNEXPIRED TERM

Students are expected to serve a one-year term; and may be re-appointed by the Commission, if student expresses an interest incontinuing service on the Commission.
TIME COMMITMENTS

Serving on a City Commission, Board, or Committee may require one or two night meetings per month, with each meeting averaging three to four hours. You may also be asked to serve on additional subcommittees. Members are expected to attend all meetings and attendance less than 75% of scheduled meetings.
APPLICANTCERTIFICATION
By signing below, I understand that the information on Page 1 and any separate attachments are subject to disclosure under the Public Records Act. The personal information on Page 2 is not subject to disclosure.*
SIGNATURE OF APPLICANT
Date*
File Upload*

Cancelof
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Application for Student Commissions

City of Sierra Madre

PERSONAL INFORMATION

COMMISSION

PERSONAL INFORMATION

BACKGROUND

INFORMATION ON THE PROCEDURE

FULL / UNEXPIRED TERM

TIME COMMITMENTS

APPLICANTCERTIFICATION