Citizen Advisory Council Application

Citizen Advisory Council Application

Please complete this application to be considered for membership to the STA Citizen Advisory Committee.
Submission Date

MonthDayYear
Hour MinutesAM/PM Option
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email

Confirmation Emailexample@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Occupation

EmployedStudentRetiredOther
Please specify
e.g. employer name, school name, or explanation
Tell us why you want to be a member of the Citizen Advisory Committee.
Tell us about yourself. Describe your experiences, affiliations, education, employment, and personal and professional accomplishments that you believe would contribute to the success of this committee. Be specific when listing organizations and responsibilities.

Would your appointment to the Spokane Transit Citizen Advisory Committee create a conflict of interest or an appearance of a conflict of interest?

YesNo
If yes, please describe.
Optional - Because we want the committee to reflect the diversity of the community, we would appreciate the following information.
Please describe any mobility challenges you've experienced using Spokane Transit services.
Being a member of the Citizen Advisory Committee is an exciting opportunity and will require your time and effort at a series of meetings currently held on the second Wednesday of the month (no meetings in January or August), from 5 pm to approximately 6:30 pm at 1230 W. Boone Ave. (unless otherwise noted).
Signature*

Clear
Date

MonthDayYear
Should be Empty:

References