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Boards, Commissions, and Focus Groups Application
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First Name
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Last Name
Company Name
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Phone
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Email Address
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Address
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City
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Postal Code
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Questions
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What Ward do you live in?
1
2
3
Not a resident
Race/Ethnicity
Hispanic or Latino
White
Black or African Amercian
Native Hawaiian or Pacific Islander
Asian
Native American or Alaska Native
Prefer not to disclose
Gender
Male
Female
Non-binary
Prefer not to disclose
First Choice
Board of Alderman
Planning Commission
Board of Adjustment
Appeals Board
Parks Board
Police Facility Community Planning Group
Generation Range
30 or Younger
31-41
42-52
53-63
64 or Older
Prefer not to disclose
Second Choice
Board of Alderman
Planning Commission
Board of Adjustment
Appeals Board
Parks Board
Police Facility Community Planning Group
Third Choice
Board of Alderman
Planning Commission
Board of Adjustment
Appeals Board
Parks Board
Police Facility Community Planning Group
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My strengths for serving on the Board/Commission/Focus Group will be:
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Education
High School, City, State, Dates attended
College/University
Institution Degree, Dates attended
Post Graduate
Institution Degree, Dates attended
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Current Employment
Current Employer, Position, Dates of Employment
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Past Employment
Past Employer(s), Address, Position, Dates of Employment
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Community Involvement
Organization, Position(s), Membership Date(s)
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Conflict of Interests
Do you have business or property interests that might place you in a conflict of interest situation should you be appointed to this Board/Commission/Foucs Group? If so, please explain.
Do you have any family members that work for the City of Odessa, if so, state name:
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