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<br />/ <br />\ y.\r:fo <br />\1-\ <br /> <br />ApPI.JI(~ATIONf.~O'R A.p.POINTl\1ENT TO <br />CITIZEN ADVISORY B()ARDS L4..~ll COMl\11SSI()NS <br /> <br />Name <br /> <br />Stephen Richard Smith <br /> <br />Human Rigbts Commission ~~~. ~. . <br />~ C0 {, - l%\\~ <br />%3 ,\\\ii \1 <br /> <br /> <br />Name of Hoard, Commission, or Committee: <br /> <br />Home Address 128 Lynnbrook Drive <br />...~........._..._.....................r;;;.~.~.sz."T'o..c.... <br /> <br />Q'7 "t:>i- <br /> <br />Home Telephone <br /> <br />(541) (i07-6424 Daytime Telephone: Same <br /> <br />Do you reside \\1thin the city limits? 0 Yes <br /> <br />litNo <br /> <br />Santa Clara (citylcounty mix) - 6 yrs <br />Springfield - to YUt'S <br /> <br />Cily Council Ward <br /> <br />NeighborhOtlO Organi7_aticm River RoadjSanta Oara Task Force <br /> <br />OccupationfPlace ofEmploymcnt Retired Auditor, Community Volunteer <br /> <br />Business Address <br /> <br />Fax number (if applicable) <br /> <br />Email {if applicable} ;!;!mHh~}~!:{!;~!;IQAgpg,rQm <br /> <br />How did you learn of this vacancy? <br /> <br />o Newspaper <br /> <br />ulWord of Mouth <br /> <br />rJI Mail <br /> <br />o Web page <br /> <br />Other source : <br /> <br />NOlI>.:: Information consisting afhome addresses and phone numbers may be exempt/rom disclosure per ORS /92.502(3). <br /> <br />OPTIONAL INFORAfA 1'lON <br />The Eugene City ('ouncil supports diversity and seeks to appoint persons who represent the diversity of the communiiy. By <br />providing the information below, you can help the City Council to A-,ww if the appointment,> match the div:ersiQ' (fthe <br />communi(v. Applicants are considered without regard to race, sex, color, national origin, age, religion, marital status, <br />medical condition. or disabi!i~v. In some instances, howm'er. appointment to certain boards/commissions may be based upon <br />the need to fill spec((ic positions on the board/commissiotl. <br /> <br />rs:( Male <br /> <br />U Female <br /> <br />o 18 and under <br /> <br />019-25 <br /> <br />026-35 <br /> <br />o 36-45 <br /> <br />U 46-55 <br /> <br />al56-65 <br /> <br />066+ <br /> <br />o African Amerk'-3n <br /> <br />a American indian! Alaskan Native <br />fII White/European American <br /> <br />o Asian/Pacific. Islander <br /> <br />o Hispanic <br /> <br />o Middle Eastern <br /> <br />o Multiracial <br /> <br />Di&1hility? <br /> <br />rJIYes <br /> <br />UNo <br /> <br />If yes, please describe: lllV and related symptoms <br /> <br />Fluent in language(s) other than English? 0 Yes <br /> <br />ONo <br /> <br />If yes, please list {non-fluent Spanisb) <br />