Application for Boards, Commissions, Committees, & Task Forces

Name of Board/Commission/Committee/Task Force:

Seat # (see Vacancy Notice for qualifications):

Full Name(Required)

First Middle Last Suffix

Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Work Phone

Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Email

Home Email

Resident of San Francisco?

Yes

If No, place of residence:

18 Years of Age or Older?

Yes

Pursuant to Charter, Section 4.101(a)(1), please state how your qualifications represent the communities of interest, neighborhoods, and the diversity in ethnicity, race, age, sex, sexual orientation, gender identity, types of disabilities, and any other relevant demographic qualities of the City and County of San Francisco:

Business and/or Professional Experience:

Civic Activities:

Have you attended any meetings of the body to which you are attending?

Yes

An appearance before the Rules Committee may be required at a scheduled public hearing, prior to the Board of Supervisors considering the recommended appointment. Applications should be received ten (10) days prior to the scheduled public hearing.

Applicant's Signature(Required)

(Manually sign or type your complete name. NOTE: By typing your complete name, you are hereby consenting to use of electronic signature.)

Date

Please Note: Your application will be retained for one year. Once completed, this form, including all attachments, become public record.

Application for Boards, Commissions, Committees, & Task Forces

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