Fillable Colr Arts Culture Application Slide 1

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Colr Arts Culture Application Slide 1

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City of Little Rock
Arts & Culture Commission Application
Applicant Information:
Telephone Number:
Email Address:
Zip Code:
Name:
Physical Address:
State:
Information provided on this form will be a public record subject to free and open examination by any person
under the Arkansas Freedom of Information Act.
Length of Residency in Little Rock:
Alternate Number:
Outline the purpose or mission of the Arts & Culture Commission:
New Applicant
Reappointment
Qualifications:
State your interest in serving on the Arts & Culture Commission:
Are you registered to vote in the City of Little Rock?
List your qualifications for serving on the Arts & Culture Commission:
Are you aware of the time commitment it would take to serve on the Arts & Culture Commission, and if
so, are you willing to make the full-time commitment?:
Self-Identification Survey
The City of Little Rock and the Racial and Cultural Diversity Commission seeks to increase diversity
in applicants for City Boards and Commissions. Your demographic information will be used to track
and enhance diversity in our Boards or Commissions.
Race/Ethnic Group: (select one or more)
White
Black or African American
Hispanic or Latino (of any race)
Asian
American Indian or Alaskan Native
Native Hawaiian or Other Pacific
Other:
Gender: Male Female
Age: 18-25 26-35 36-45 46-55 56 & over
How did you learn of this Board/Commission vacancy?
City Website Community Agency, specify
Referred by Board/Commission Member Newspaper, specify ____________
Referred by City Director or Staff Other, specify
Local Government Access Channel
The City Code of Ethics prohibits any the member of any City Board, Commission or
Authority, from voting on a matter in which the member has an interest, or the member’s
family or business has an interest. If such a matter comes before the body to which you are
appointed, and there is any question about recusal, you should contact the City Attorney’s
Office for an informal or formal opinion as to the propriety of your participation.
Please submit a current resume, along with your application to: Little Rock City Clerk’s
Office, 500 West Markham Street, Room #200, Little Rock, AR, 72201, by e-mail to
cityclerksoffice@littlerock.org, or by fax to (501) 371-4857.
Board and Commission meetings may require day or evening attendance. For
more information regarding Boards/Commissions, including meeting times and
duties please please visit www.littlerock.org/citycommissions
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Colr Arts Culture Application Slide 1

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Completed 1 November 2019

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