HomeMy WebLinkAbout2011-10-12 PACKET 03.Retum to:
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City Clerk's Office
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Cottage Grove, MN 55016
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or fax to (651) 458 -2897
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['Name —_
Date
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Please rank in order the commissions on which you would like to serve (leave blank any on which you
do not wish to serve):
i� Historic Preservation
I I Human Services /Human Rights f Public Safety, Health & Welfare
w i Parks, Recreation & Natural Resources 1 Public Works
Cable Telecommunications Other:
Do you have any special qualifications that you feel would help you be particularly effective on a
commission (i.e. work experience, volunteer experience, e { { ucation, hobbies, etc.)? 0
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List two ct three goals that you would like ko see accomplished during your term on a ` commission.
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How did you became interested in serving on a commission? _' 3
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The City strives to have a variety of people serving on its advisory commissions. The following
in *" is o ticnal, but would be helpful to u in achieving our goal of balance
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S x � .1 Age , Racial /Ethnic Group , � { r Years as Reside. t . C t
THIS A ATION WILL BE KEPT ON FILE FOR ONE YEAR FTER DATE OF SUBMITTAL. PLEASE CONTACT
CITY CLERK CARON 5TRA.NSKY WITH ANY QUESTIONS AT (651) 458 - 2814.
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