COC Application rev. 3/13/18 Page 1 of 2
Application for Membership
Applicant Name:
Best Phone (#s) at which to be reached:
Physical Address of Residence:
(This must be a physical address to verify that you live within District boundaries.)
Please check the following constituencies that you could represent (Check all that apply):
Foundation Representative Active in a support organization for the college, such as a
Senior Representative - Active in a senior citizens’ organization
Student Representative Student enrolled and active in a community college support group,
such as student government
Taxpayers Representative- Active in a bona-fide taxpayers’ association
Member of the Community at Large
NOTE: All members of the Measure L Citizens’ Oversight Committee must be residents of the San
Joaquin Delta Community College District (“District”). Employees, vendors, contractors, and
consultants of the District are prohibited by law from being members of the Citizens’ Oversight
Committee. Employment that could result in becoming a contractor or subcontractor to the District
would also be a potential conflict.
Meetings are held on one Thursday evening during the months of February, May, August and
November. Please indicate “YES” or “NO” to the following:
Do you have conflicts that would preclude your attending the quarterly meetings? YES
Do you know of any reason, such as a potential conflict of interest, which would adversely
affect your ability to serve on the Independent Citizens’ Oversight Committee? YES NO
Are you willing to comply with the ethics code included in the bylaws
It is the policy of the San Joaquin Delta Community College District (SJDCCD) not to unlawfully
discriminate on the basis of sex, sexual orientation, gender, ethnic group identification, race,
ancestry, national origin, color, religion, marital status, age or mental or physical disability in the
educational programs or activities which it operates.
COC Application rev. 3/13/18 Page 2 of 2
Why do you want to serve on the Measure L Independent Citizens’ Oversight Committee?
Do you have any particular area of expertise or experience (e.g., work, previous other
committee experiences, etc.) that you think would be helpful to the committee?
Please note any additional information you feel should be considered as part of your
Signature of Applicant:
All answers and statements in this document are true and complete to the best of my knowledge.
____________________________________________ ___________________________________
Signature Date
Return this Application to: Office of the Vice President of Operations, SJDCCD, 5151 Pacific Avenue,
Stockton, CA 95207 or scanned and emailed to:
by the specified
[Application should not exceed two 8.5” x 11” pages.]
click to sign
click to edit