Application for HCNC Committee Member

This form is to be filled out in order to apply to be a member of one of the Harbor City Neighborhood Council Committees. We will review the applications and may appoint the new committee member at the next scheduled Committee meeting. Any committee will be limited to 5 committee members. If you have any questions please call 310-918-8650.

Name *

First Name Middle Name Last Name

Residence Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Area Code Phone Number

Email *

example@example.com

You must be at least 16 years of age and a stakeholder within the Harbor City Neighborhood Council boundaries to qualify as a committee member. Stakeholders are defined as anyone who lives, works or owns real property within the neighborhood and also those who declare a stake in the neighborhood as a community interest stakeholder, defined as a person who affirms a substantial and ongoing participation within the neighborhood council's boundaries and who may be in a community organization such as, but not limited to, educational, non-profit and/or religious organizations. [Definition text mandated by Los Angeles Administrative Code SS22.811(a)(2)]

Which committee are you interested in joining?

Outreach Committee Budget & Finance Committee Planning & Land Use Committee Start your own Committee

Stakeholder Status. *

I am a resident within the boundaries of the neighborhood council at the address below. I own a business or work within the neighborhood council boundaries. I own property within the boundaries of the neighborhood council at the address below. I have a vested interest in the neighborhood council based on the information below.

Enter the address and/or name of the organization/place of employment which qualifies you as a Stakeholder. *

Please share why you wish to be part of the disired Committee: *

Please share any experiences, skills or knowledge you have that would contribute to the disired committee: *

Are you willing to commit the time required to be a member of the disired Committee (estimated at one meeting per month with volunteer time in between for HCNC events etc.)? *

Electronic Signature (Type your name here) *

Signature date *

Application to be a Harbor City Neighborhood Council Committee Member