Community Advisory Committee Application

2. First Name*

3. Last Name*

5. Do you live or work in Dublin?*

   1. Live
   2. Work
   3. Both

7. Address1*

9. Address2

11. City*

12. State

13. Zip*

15. Phone Number*

16. E-mail Address*

18. Demographic Information:
    The following questions will help the City of Dublin select a diverse advisory committee membership identified by the City Council:

    The following questions will help the City of Dublin select a diverse advisory committee membership identified by the City Council:

20. Gender:*

    1. Male
    2. Female
    3. *Other (please specify in the space provided below)
    4. Prefer not to answer

22. *Gender response from above (if applicable):

24. Which of the following best describes you?*

    1. Asian or Pacific Islander
    2. Black or African American
    3. Hispanic or Latino
    4. Native American or Alaskan Native
    5. White or Caucasian
    6. Multiracial or Biracial
    7. A race/ethnicity not listed here
    8. Prefer not to answer

26. Age*

    1. 14-18 years old
    2. 19-24 years old
    3. 25-34 years old
    4. 35-44 years old
    5. 45-54 years old
    6. 55 or older
    7. Prefer not to answer

27. I am a (check all that apply):*

    1. Homeowner
    2. Renter
    3. Business Owner
    4. Property Manager
    5. Student
    6. None of the above

29. Occupation (if applicable):*

31. Statement of Qualifications:

33. Why are you interested in serving on the Community Advisory Committee?*

35. What relevant life or professional experience makes you a good candidate for the Community Advisory Committee?*

37. What is the most important contribution you can make as a member of the Community Advisory Committee?*

39. What should the City consider when reviewing mixed-use (commercial and residential) developments on the SCS Property?*

41. The Community Advisory Committee will meet three times between May 2021 and January 2022. The meetings will be held in the evening, Monday - Friday. Please provide the following:

43. Days you are generally most available:*

45. Specific dates when you are not available (e.g., planned vacations):

47. Additional comments:

49. Application deadline: Wednesday, April 21, 2021, at 5:00 p.m.

    Application deadline: Wednesday, April 21, 2021, at 5:00 p.m.

Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit Submit and Print

* indicates a required field