City of Bryant Community Engagement Committee Application

2. Personal Information

4. First Name*

5. Last Name*

7. Race/Ethnicity
   -- Select One --American Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or other Pacific IslanderWhite

   THE CITY OF BRYANT IS AN EQUAL OPPORTUNITY COMMUNITY PARTNER, CELEBRATING DIVERSITY AND COMMITTED TO CREATING AN INCLUSIVE ENVIRONMENT FOR EVERYONE.

8. Age
   -- Select One --18-2425-3435-4445-5555-6565+

10. WARD*
    -- Select One --1234

12. Address1*

14. Address2

16. City*

17. State*

18. Zip*

20. Home Phone Number*

22. Business Address*

24. Business Phone Number*

26. Occupation*

28. Email Address

30. Length of Residency in City*

32. Are you a registered voter

    1. Yes
    2. No

34. Education and Hobbies

36. High School

38. College

40. Trade or Business School

42. Hobbies

44. Organization Membership Information

46. Are you currently serving on other Boards, Commissions, or Committees?*

    1. Yes
    2. No

48. If yes, please list

50. Have you served on a Board, Commission, or Committee before?*

    1. Yes
    2. No

52. If yes, which

54. Please list organization memberships and positions held.

56. Please list areas of special interest specific to city or community development.

58. Community Engagement

    Define what you believe Community Engagement should look like in our city.

60. Community Engagement

    What responsibilities do you believe the city has in regards to leading positive community engagement in our communities?

62. Community Engagement

    What responsibility do you believe Bryant residents have in leading positive community engagement in our communities?

64. Committee Goal

    If you are selected to serve on the City of Bryant Community Engagement Committee, what is ONE thing you would like to see the committee accomplish or improve the first year it is in place?

66. Upload Resume

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68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit

* indicates a required field