Citizen Advisory Committee Application

Citizen Advisory Committee Application

Please complete this application to be considered for membership to the STA Citizen Advisory Committee.
Date* First Name* Last Name Preferred Name*
Address* City* State* Zip*
Email* Area Code Phone Number
Employer (name of school, if student) Employer or School
Tell us why you want to be a member of the Citizen Advisory Committee.*
Describe your experiences, affiliations, education, employment, personal and professional accomplishments, and leadership positions you have held (either paid or as a volunteer) that you believe would contribute to the success of this committee. Be specific when listing organizations and responsibilities.*

Disability?

YesNo
Current and past positions held on any boards, committees or commissions:Position: Position Dates: Dates Position: Position Dates: Dates Position: Position Dates: Dates
How would you gather information from the community to bring to the CAC, and how would you take information from the CAC and circulate it back into the community?*
How do you usually get around Spokane (check all that apply)?*

Personal automobile/motorcycleBicycleWalkingParatransitVanpoolBus
If you ride the bus, please list the routes your use: Bus Routes
List two references who can speak to your qualifications for CAC membership. Please include telephone numbers and email addresses:Name: Name Phone: Phone Email: EmailName:Name Phone: Phone Email: Email

Would your appointment to the Spokane Transit Citizen Advisory Committee create a conflict of interest or an appearance of a conflict of interest? If yes, please describe:*
Optional - Because we want the committee to reflect diversity of the community, we would appreciate the following information. Age (range is sufficient)Age Preferred Gender Pronouns (e.g., he - him, she - her, they - them, etc.) PronounEthnic Origin Ethnicity
Please describe any mobility or other challenges you’ve faced using Spokane Transit services.
Please verify by initialing the statements below.I certify that I am a citizen of the United States of America Initials* (initials).I certify that I reside within the Spokane County Public Transportation Area (PTBA), or am a consistent user of STA's fixed route, paratransit or vanpool services. Initials* (initials).Being a member of a Citizen Advisory Committee is an exciting opportunity and will require your time and effort at a series of meetings currently held the second Wednesday of the month (no meeting in August), from 5:00 p.m. to approximately 6:30 p.m. at 1230 W. Boone Avenue (unless otherwise noted).
Signature*

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Date*

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