COC Application rev. 3/13/18 Page 1 of 2
Application for Membership
MEASURE L CITIZENS’ OVERSIGHT COMMITTEE
Date:
Applicant Name:
Best Phone (#s) at which to be reached:
Email:
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
foundation
☐ 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 ☐
NO
• 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
? ☐ YES ☐ NO
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.
