Measure T
Citizens’ Bond Oversight Committee
APPLICATION FORM
(Please Print or Type)
Name: Email:
Home Address: City: Zip:
Home Phone: Mobile Phone: Fax:
Employer: Employer Phone:
Employer Address: City: Zip:
I can represent the following constituencies located in the Measure T taxing district (check all that apply):
Business Representative Active in a business organization representing the business community located in the HCCD
Name of organization
: ________________________________________________________________________________
Senior Citizen Group Representative Active member in a senior citizens’ organization
Name of organization
: ________________________________________________________________________________
Taxpayer Organization Member Active in a bona fide taxpayers’ organization
Name of organization
: ________________________________________________________________________________
Hartnell College Student Currently enrolled and active in a college organization
College Group(s)
: ___________________________________________________________________________________
Member of College Support Organization Active in the support and organization of the District (e.g. Hartnell College
Foundation, Athletic Boosters, etc.)
Name of organization
: ________________________________________________________________________________
At Large Community Member Resident within the boundaries of the HCCD
Current affiliate organizations and/or community group memberships:
Please describe your interest in serving on the Citizens’ Bond Oversight Committee and what specific experience you may
have that may be helpful (use additional sheet, if necesary):
I am applying to serve on the Citizens’ Bond Oversight Committee. I have read the conflict of interest information in the Ethics Policy
Statement and I do not have a conflict of interest that would prevent me from serving on the committee. I agree to report any such
conflicts to the committee chair and district administration should it arise. I understand that this position is a community service,
unpaid, volunteer position. I certify that I am not an employee, vendor, contractor, consultant, or official of the Hartnell Community
College District. I certify that I am a resident within the HCCD.
Signature: Date:
Hartnell Community College District
Office of the Superintendent/President
411 Central Avenue, Salinas, CA 93901
Tel. (831) 755-6900 Fax (831) 753-7941
Email: lserrano@hartnell.edu
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome