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<br />ATT A'CHMENT A <br />, ~ECE'VED <br />BY CJTY MANAGt:R <br />ApPLICA TION FOR ApPOINTMENT TO .SEP 1 2006 <br />CITIZEN ADVISORY BOARDS AND COMMISSIONS <br /> <br />en. w~ '-\.lll ~ to <br /> <br />G <br /> <br />Name of Board, Commission, or Committee _East Alton Baker Park Citizen Planning Committee _ <br /> <br />Please print or type <br />Name _ Vicky M Mello <br /> First Middle Last <br />Home Address _PO Box 30143 Eugene 97403 <br /> Street City Zip <br />Home Telephone --- 541 484-9806 Daytime Telephone SAME <br /> <br />Do you reside within the city limits? lEI Yes <br /> <br />ClNo <br /> <br />If yes, how long? _11 yrs <br /> <br />City Council Ward 4 <br /> <br />Neighborhood Organization Cal Young Neighborhood Assn <br /> <br />OccupationIPlace of Employment _Retired <br /> <br />Business Address <br /> <br />Fax number (if applicable) <br /> <br />Email (if applicable) <br /> <br />How did you learn of this vacancy? <br /> <br />(J Newspaper <br /> <br />IXI Word of Mouth <br /> <br />CI Mail <br /> <br />CI Web page <br /> <br />Other source <br /> <br />NOTE: Information consisting ofhome addresses and phone numbers may be exemptfrom 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 conditio~ or-disability. 'In some instances, however, appointment to certain boards/commissions may be based upon <br />the need to fill specific positions on the board/commission. <br /> <br />(J Male <br /> <br />(B] Female <br /> <br />a 18 and under <br /> <br />Q 19-25 <br /> <br />CI 26-35 <br /> <br />[J 36-45 <br /> <br />[8]46-55 <br /> <br />CJ 56-65 <br /> <br />[J 66 + <br /> <br />Q African American <br /> <br />CJ' .American IndianlAlaskanNative <br /> <br />I:JAsianlPacific Islander <br /> <br />[J Hispanic <br /> <br />a ' Middle Eastern <br /> <br />lBlWhite/European American <br /> <br />[J . Multiracial <br /> <br />Disability? <br /> <br />CI Yes <br /> <br />IXI No <br /> <br />If yes, please describe <br /> <br />Fluent in language(s) other than English? [J' Yes <br /> <br />(EJ No <br /> <br />If yes, please list <br /> <br />C:\Documents and Settings\Laurie J. Anderson\Local Settings\Temporary Internet Files\Content.IES\M9YD8XEv\CPC2006BCCapplication-l.doc <br />