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RECEIVED <br /> <br /> o 005 <br />APPLICATION [:OR APPOINTMENT TO <br />CITIZEN ADVISORY BOARDS AND COMMISSIONS <br />Please P~nt or Type. I I <br /> <br /> Citizens Planning ~miEee, Whilamut NaOmi ~a of Alton Baker Pa~ <br />Board or Commission <br /> <br /> Grog Ringer <br />Name <br /> F~ Mldd~ Le~ <br />Hom Address 872 Polk St Eugene ~OR 97402~536 <br /> . S~et c~ ~ Zip <br /> <br />Do you reside w~hin the City limits? ~ Yes ~ No If ~s, how long? 18 yearn <br /> <br />City Council Ward ~1 Nelghbo~ood Organization Jeffemon-Westside <br /> <br /> 541 345-8545 <br />Home Telephone Day Tele~one <br /> · ~st Pmf~or (AdD / InternatiOnal ~r~ ~nsultant <br />Occupation Place of Employment ~/Self-employed <br /> <br />Business Address Planning, Public Policy & Management, UO, 119 Hendri~s Hall, Eugene 97403-1209 <br /> 541 346-2040 gringer~uor~on.edu <br />Fax Num bar (ff applicab~) E-Mail (If applicable) <br />HOW did you learn ofthis va~ncy? ~Newspaper ~Word of mouth ~Uail ~Web Page <br /> <br />Other Source <br />I I I <br /> <br />OPTIONAL INFORMA ~ON <br />The Eugene Ci~ Counc8 ~ppo~s divers~y end seeks to appoint persons who represent ~e dlvers~y of ~e commun~y. By <br />providing ~e in~rmetion below, you can help the C~y Council to know if ffia appoin~entS match ~e divers~y Of the <br />community. Applicants a~ considered.w~hout rege~ to mca, sex, colo~ na~onal or~in, age, minion, mafl~l ~tus, medical <br />condi~on, or disabili~, in some instances, however, appointment ~ cedain boards/commissions may be based upon the <br />need to fi8 specE~ posi~ons on the boe~YcOmmis~n. <br /> <br />please check ~e appliCable boxeS~ <br /> <br />~] Male [] Female <br /> <br /> [] 18 and Under [] 19,25 , : ~ 26~35 ~. [] 36-~45 .... , ~[] 46'55,. ' ~ r <br /> [] 56 - 65 [] 66 and above <br /> <br /> [] African American [] American Indian/Alaskan Native [] Asian/Pacific Islander <br /> [] Hispanic [] Middle Eastern [] Multiracial <br />~ White/European American <br /> <br /> Disability: [] Yes [] No If yes, please describe Hodgkin's disease~ in remission <br /> <br /> Fluent in languages other than English? [] Yes [] No Which language(s)? <br /> <br /> Lao, German, Spanish (reading & conversational) <br /> <br />P/ease (x)rnplete both s/des of ~ls application Application for Appointment to Citizen Ae/Is=¥ Boards and Commissions- Page 1 <br /> Revised September, 2001 - P:~CMO~BCC~BCCAPP0109119,wpd <br /> <br /> <br />