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<br />ApPLICA TION FOR ApPOINTMENT TO <br /> <br />CITIZEN ADVISORY BOARDS AND COMMISSIONS <br />For Human Rights Commission March 2007 Interim Position only <br /> <br />c <br /> <br />Name of Board, Commission, or Committee Human Rights Commission <br /> <br />Please print or t;ype <br /> <br />Nanle <br /> <br />Marieke (Mo) <br />First <br /> <br />Opal Carlson <br />Middle <br /> <br />Y bung <br />Last <br /> <br />HOlne Address. <br /> <br />) 565 Norkeniie Rd <br />Street <br /> <br />Eugene <br />City <br /> <br />97401 <br />Zip <br /> <br />Home Telephone <br /> <br />(541) 505~ 7980 <br /> <br />DaytimeTeJephone (541 )221-) 375 <br /> <br />Do YOll reside with in the city .Hm its? X Yes <br /> <br />DNo <br /> <br />If yes, how long? 25 years <br /> <br />City Cou.ncil Ward I think Ward 1 <br /> <br />Neighborhood Organization <br /> <br />Occupation/Place of Employment: Community Alliance of Lane County, Program Co-Coordinator. Back to Back: Allies. for <br />HUJna.n Dignity <br /> <br />Busines.s Address <br /> <br />458 BlaIr Blvd.; Eugene, OR 97402 <br /> <br />Fax number (if applicable) <br /> <br />Email (ifapplicable)beatjunkyl@hotinail.com <br /> <br />How did you learn of this vacancy? <br /> <br />o Newspaper <br /> <br />X Word of Mouth <br /> <br />[JMail . <br /> <br />o .Web page <br /> <br />Other source <br /> <br />NOTE: lriformation consisting of home addresses and phone numbersmay be exempt from di<;c!osure 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 iii/ormation 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, mariial status, <br />medical condition, ordisabi/ity. In some instances, however; appointment to certain boards/commissions may he base1 upon <br />the need toftll specific.positions on the board/commission. . <br /> <br />o Male <br /> <br />X Female <br /> <br />a 18 and under <br /> <br />o 19-25 <br /> <br />X 26-35 <br /> <br />D 3~-45 <br /> <br />046-55 <br /> <br />[J 56-65 <br /> <br />066+ <br /> <br />~.. -- <br /> <br /> <br />Disability? <br /> <br />DYes <br /> <br />XNo <br /> <br />If yes, please describe <br /> <br />Flu.ent in language(s) other than EngJ ish? X Yes <br /> <br />DNo <br /> <br />If yes, please list: French <br /> <br />C:\Docume~ts andSettings\fcrguson jenkins\Desktop\mo's docunlcnts\IIRC app.doc . <br />