Bassett Creek Watershed Management Commission
(BCWMC) Application
To apply for the BCWMC, fill out an application and email to Tomás Romano at tromano@goldenvalleymn.gov. Applica-
tions are due by Jan 11, 2021 at 4:30 pm. The City Council will consider appointments at its Jan 19, 2021 meeting and may
contact applicants prior to the meeting for interviews.
General Information
Name Phone
Address City State Zip
Email
Questions
Briefly explain your desire to be appointed as a BcWMC Commissioner, and list any qualifications or prior experience you
believe make you a desirable candidate.
Briefly describe any prior experience in collaborating on projects or initiatives that protect or enhance water quality.
Signature
Data Practices Advisory
Signature
X _________________________________________
Date
Physical Development-Engineering Department | 7800 Golden Valley Road, Golden Valley, MN 55427
763-593-8030 | FAX: 763-593-8109 | TTY: 763-593-3968 | www.goldenvalleymn.gov
12/22/20
This document is available in alternate formats upon a 72-hour request. Please call 763-593-8006 (TTY: 763-593-3968)
to make a request. Examples of alternate formats may include large print, electronic, Braille, audiocassette, etc.
Minnesota law requires that you be informed of the purpose
and intended use of the information you are providing on
this application. Per Minnesota Statute 13.601, subd. 3a, your
name, address, length of residence, occupation, educa-
tion, training, civic aliations, qualifications, experience, and
veteran status are public data and available to anyone who
requests the information.
This information will be used to identify you as an applicant,
enable us to contact you when additional information is
required, send you notices, and assess your qualifications for
appointment. This data is not legally required, but refusal to
supply the information requested may aect the City Council’s
ability to accurately evaluate your application.
Should you be appointed to a City of Golden Valley Board
or Commission, your residential address and either a phone
number or email address where you can be reached will also
become public information (per Minnesota Statute 13.601,
subd. 3b). The purpose is to list contact information for Board/
Commission members on a public roster.
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