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You are applying for the following seat.

Seat#	Term Name	Term Start	Term End	Appointing Authority	Membership Requirements
{{$index == 0 ? applicationSeat.SeatNo : ""}}	{{applicationSeat.TermName}}	{{applicationSeat.TermStartDate \| date : common.constants.DATE_FORMATE}}	{{applicationSeat.TermEndDate \| date : common.constants.DATE_FORMATE}}	{{applicationSeat.AppointingAuthority}}	{{applicationSeat.MembershipNote}}

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Please use the name you wish us to use on paperwork and public documents; it does not need to be your legal name if you go by a different chosen name.

Information provided on fields with this icon is public according to the Minnesota Data Practices Act. Any information you provide in these fields may be made available to the public.

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Applicant Details

First Name

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Middle Initial

Last Name

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Suffix

Home Address

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City

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State

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Postal Code

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Ward

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Phone

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Email Address

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Employer Information

Employer Name

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Occupation

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Employer Address

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City

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State

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Postal Code

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Work Phone

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Note: If appointed, Minnesota statute 13.601 requires that a telephone number and/or an email address where the appointee can be reached and residential address will be considered public data.

Public Contact Preference

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Describe your education and training, employment history, and volunteer work related to this position. Include applicable experience with civic, professional, or volunteer organizations and other city boards and commissions, including any awards or special recognition.

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Describe the reasons why you would be a good candidate to serve on this body.

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List the issues that you believe the committee should address

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References: List names, addresses and telephone numbers of no more than 3 references

Name

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Address

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Phone Number

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List any financial interests (where required) or associations with which you are involved that may present a conflict of interest

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I have reviewed the requirements for this seat and meet the requirements. I understand that I will only be contacted if I am selected to move forward.

If you need help with this information, please contact 311.

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