2. YOUTH COMMISSIONER APPLICATION for July 1, 2023- June 1, 2024 (Application Deadline = March 31, 2023)
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6. Please select which Committee you are applying for:

   1. Arts Commission
   2. Bicycle and Pedestrian Advisory Committee
   3. Historical Commission
   4. Library Advisory Board
   5. Open Space Committee
   6. Parks & Recreation Committee
   7. Climate Action Commission
   8. Racial Equity Committee
8. Today's Date:*
10. First and Last Name:*
12. Email: *
14. Are you a San Anselmo resident? *
16. High School Name:*
18. What Grade will you be in, in the Fall?*
20. Favorite Subjects:*
22. Other interests or hobbies:
24. Parent or Guardian Name(s):*
26. 
    
28. Please list one or two organized activities that you have participated in:
30. Activity/Sport
31. Year
32. Coach/Teacher
34. Activity/Sport
35. Year
36. Coach/Teacher
38. 
    
40. Please tell us why you wish to apply for this appointment:*
42. 
    
44. Please tell us how you think you can help the Commission/Committee:*
46. 
    
48. Please tell us what you think are the most important issues facing the Commission/Committee:*
50. 
    
52. Name and phone numbers of up to three adults who can be contacted for referral information (example: teacher, employer, coach, neighbor...):
54. 1.) Name*
55. Phone*
57. 2.) Name
58. Phone
60. 3.) Name
61. Phone
63. 
    
65. I would be able to attend monthly (or quarterly) meetings of this Committee/Commission:*

    1. YES
    2. NO
67. 
    
69. I would be able to serve for a period of one year:*

    1. Yes
    2. No
71. 
    
73. I am familiar with the responsibilities & functions of this Committee/Commission:*

    1. YES
    2. NO
75. 
    
77. I understand that I and all other applicants will be personally interviewed by the Committee/Commission as part of the selection process for this appointment. I also understand that my application material will be a public document (email address will be redacted), and available on the Town's website. Sensitive materials that you don't wish to be posted on the website should not be included with the application.**

    1. Yes
79. 
    
81. 
    
83. Optional: You may attach resume or other documents that you believe will be helpful for the selection process:
85. Thank you for your interest in serving the Town of San Anselmo and its citizens. For further information, please contact the Town Clerk, at 415-258-4660 or townclerk@townofsananselmo.org.
Leave This Blank:


87. 1. Receive an email copy of this form.
88. Email address

    This field is not part of the form submission.

89. Submit Submit and Print

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