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<br />ATTACHMENT C <br />RECEIVED <br />. BY CITY MANAGER <br />ApPLICATION FORAPPOINTMENTTO. OClIO 2006 ~ <br />CITIZEN ADVISORY BOARDS AND COMMISSIONS .., <br /> <br />Name of Board, Commission, or Committee Metropolitan Wastewater Management Commission <br /> <br />Please print or type <br />Name <br /> <br />Terry C. Gould <br />First <br /> <br />Middle <br /> <br />Lost <br /> <br />Home AddreSs <br /> <br /> <br />Zip <br /> <br />Home Telephone <br /> <br />Daytime Telephone 541 285-6744 <br /> <br />Do you reside within the city limits? X Yes <br /> <br />[JNo <br /> <br />If yes, how long? 33 years <br /> <br />City Council Ward 1 <br /> <br />Neighborhood Organization ~onny Bettman <br /> <br />OccupationIPlace of Employment Environmental Engineer at BROWN.AND CALDWELL <br /> <br />Business Address Home address <br /> <br />Fax number (if applicable) _ <br /> <br />Email (ifapplicable)jtgould@eartlink.net <br /> <br />How did you learn of this vacancy? <br /> <br />CJ Newspaper <br /> <br />X Word of Mouth <br /> <br />CJ Mail <br /> <br />l:I Web page <br /> <br />Other source <br /> <br />NOTE: Information consisting of home addresses and phone numbers may be exempt from disclosure per ORS 192.502(3).. <br /> <br />. OPTIONAL INFORMATION <br />The Eugene City Council supports diversity and seeks to appoint persons who represent the diversity of the community. By <br />providing the information below, you can help the City Council to know if the appointments match the diversity of the <br />community. ' Applicants are considered without regard to race, sex. color, national origin, age, religion, marital status, <br />medical condition, or disability. In some instances, however, appointment to certain boards/commissions may be based upon . <br />the need to fill specific positions on the hoard/commission. <br /> <br />X Male <br /> <br />[J Female <br /> <br />Q 18 and under <br /> <br />1:119-25 [J 26-35 Q 36-45 [J 46-55 X 56-65 <br /> <br />1:1 66 + <br /> <br />0.. Afiica.n.American <br /> <br />Cl. American IndlalllA1askanNative <br /> <br />0: Asian/Pacific.lslander <br /> <br />0........ fij$panie <br /> <br />tJMi4ale. Ea$t.eM. .... <br /> <br />. -,_. . -.' . .... . . <br /> <br />*.'\Vf.dt~urQ~AlDefi~l.1 <br /> <br />..Q:MUltitaci8J. <br /> <br />. '.. . .... -, ". <br /> <br /> <br />Disability? <br /> <br />aVes <br /> <br />XNo <br /> <br />If yes, please describe <br /> <br />Fluent in language(s) other than English? X Yes <br /> <br />f:1 No <br /> <br />If yes, please. list Spanish <br /> <br />C:\Documents and Settings\tgould\My Documents\MWMC\2006BCCapplication[ 1 ].doc <br />