CITY CLERK
........ ~
Freniont
JAN 2 6 2022
CITY OF FREMONT
Board and Commission Application
Board or Commission you wish to serve on: HI ~·1oRlc Al AR.c.111Tf CT UllE 1«-v,1=.w Bc,AAI> (Planning Commission applicants: Please attach supplemental questionnaire) Submit application to:
Office of the City Clerk
3300 Capitol Avenue, Building A
P. 0. Box 5006
Fremont, CA 94537-5006
Personal Information:
Mr. □
Mrs. □
Ms. □
Name: PAiEL -----L-a-st---------F,-rs-t _________ M_I ___ _ HomeAddress: REMONi
Street City
cA
State
Zip
Home Telephone: Work Telephone: _________ _
E-mail: Fax:
-----------
Resident of the City of Fremont: __ 1._._2 ___ years
Demographic Information:
Ethnicity:
□ American Indian or Alaskan Native
□ Black or African American
□ Afghan
□ Mexican
~ndian
□ Chinese
o White
□ Vietnamese
o Filipino
□ Pakistani
□ Other Asian origin: _______ (write-in optional)
o Other African origin: (write-in optional)
o Other Hispanic, Latino, or Spanish origin: _____ (write-in optional) -1-
Gender:
'01\llale
□ Female
□ Prefer to self-identify
□ Prefer not to say
Language(s) Spoken: E tJ 4--Ll ~H, HI "10 l, 6,-i.JJ ARAiI.
Background Information:
Vl/hy do you wish to serve as a member of this Board or Commission: I am a Fremoo t yes/QefJI:: .s-,oce 1-t-!j-ecn 2'.)QLC. ·r hye m the heaubp,J r ,
ant!, ale. o 4e ah tau </ a cb111 he ~ ftatte111~ i rz &mfru- y.,"J •flt- Ai:rhrr-t c pa0pe 1fre,,g,.
What would you bring by way of perspective or experience to this Board or Commission: __ Employment/Volunteer Information:
Please list any qualifications you feel would provide positive input to the work of the commission.
Organization: A Mazon 't. nc · Dates: oi} Las/ o?,o{A . hll cf 6.U I Location: lv1rd!-l1j -{am &mg. Position(s): ~ c,f-fv,.n;n~ J>evc/o:(?mfflt: Gu,tn.a?IY.
Responsibilities/accomplishments: ~e 3 m St hie fx d;J,rJ.'f 'if/.frll."" aff'!d I '
'.h1 a,hd'fLiAllt.ll! f , r4wwYI i (!1)1.J. 'i sly k <hap a ,per, etl.(£ .
Organization: __;;;e.=/3=4Y::;;;;.;f------------ Dates: 05/,Ra 16 Jp 0.4/ie(JcUJ.
Location: ~ o{-IV,rttr. f ngfriet" X:::
Responsibilities/accomplishments: _...,,,~-r,c-1'-"'tff-"--"------1"--',.,1,"f-+<~~-------- -2-
:JP fv1D68ttn chase gank-
Organization: lt8:µ2a 1.t, f-, CJs/r2:B 1t Dates: CJ~f<, o/?, l-o C5/-WI{ Location: HotlSttrll ; ·rx Position(s): Assouate hvclt¢e·¥ Responsibilities/accomplishments: _l._.u .... · .... i ... ( .... d...._ _ _..( a/fz""+-' ........ irrl...-..l"""Z:,..:::&......__,.·Jw--=-.__.J.j/neu..u. ....... Y--__./ra..::....i.o1..1r.la~· Organization: _________________ Dates: ________ _
Location: ______________ Position(s): ___________ _
Responsibilities/accomplishments: ____________________ _ Community Activities that you have been involved with (feel free to attach separate pages):
Name of Organization Position/Responsibilities/Accomplishments Dates Name of Organization Position/Responsibilities/Accomplishments Dates Special awards or recognitions you have received: _____________ _ Education Information:
Degree/Diploma Year
-3-
Educational Institution Degree/Diploma Field Year
Additional Information (Please provide any other information which you feel would be useful to the City Council in reviewing your application.)
i;,& n b-£LQ rts; ,Lrza t: fr1 F-wumt-1 th.at :/.m? i1'.J C< t:, ~ci~ 1~ ;;:::at:; ~~ t:;z· =H=-
:ll, ·J!> 6:i1 I: a l&o lx s A-ate fa_,"YJli, .uad cu1J, e 1eutit Civic service is a privilege and responsibility of interested, qualified, sincere citizens. The value and importance of wide participation of a large number of citizens cannot be measured. Your interest in serving on a board or commission of the City of Fremont is greatly appreciated.
General Information: Your application is a public document and will be kept on file for one year.
If you would like additional information, please call the City Clerk's Office, at (510) 2844060.
Please sign and date your application and submit to the Office of the City Clerk.
Thank you. /'
6\~o.1
Signature?"". _ Date
-4-