Risk and Emergency Management Advisory Committee Application 2021-2022

Risk and Emergency Management Advisory Committee Application 2021-2022
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State

Zip Code
Primary Number *

Area Code Phone Number
Cell Number

Area Code Phone Number
Email *
example@example.com
If you are not a resident of the school district but you work in the community, please provide the following:
Name of Employer
City of Employer
Position/Title
Do you have children age 18 and younger *

Yes No
Child 1
Age and School Attending
Child 2
Age and School Attending
Child 3
Age and School Attending
Child 4
Age and School Attending
Please describe why you are interested this work and how you will contribute to the purpose of the Advisory Committee. *
Check one (optional)

Male Female
Check as many as apply (optional)

African or African American American Indian/Alaskan Native Asian and Pacific Islander Latinx White More than one of the above
The information requested above is collected in order to assist with the selection of members for the Risk and Emergency Management Advisory Committee. The information will be used to help ensure that Advisory Committee members reflect diverse perspectives among the families and community members served by the school district. You are not required to provide the information; however, failure to do so may result in the selection team’s inability to fully consider your potential contributions to the Advisory Committee. If you are selected as a member of the Advisory Committee, your name and your employment information (if applicable) will become public data, in accordance with Minn. Statute § 13.43.
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