SRJC Board of Trustees Ad Hoc Racial Justice Committee Application Form

Name

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

How many years have you resided in Sonoma County?

Present Occupation

Work Experience

Organization/Business

Dates

Position

Add another work experience?

Yes

Organization/Business

Dates

Position

Add another work experience?

Yes

Organization/Business

Dates

Position

Community Service Experience

Organization

Dates

Position

Add another community service experience?

Yes

Organization

Dates

Position

Add another community service experience?

Yes

Organization

Dates

Position

Other relevant experience/expertise

Are you currently a member of other SRJC or community boards, organizations, committees or commissions?

Which activities of this committee interest you the most?

What would be your goal as a committee member?

What do you feel you could contribute to see these goals realized?

Please list two local references and their contact details (phone number and email)

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