-1-
Board and Commission Application
Board or Commission you wish to serve on: ___Recreation Commission_______
(Planning Commission applicants: Please attach supplemental questionnaire)
Submit application to:
Office of the City Clerk
3300 Capitol Avenue, Building A
P.O. Box 5006
Fremont, CA 94537-5006
Personal Information:
Mr. q
Mrs. q
Ms. q
Name: ______Nanavati______________________Chaya____________________ Last First MI
Home Address:
Street City State Zip
Home Telephone: ___ ________ Work Telephone: _______________________
E-mail: ___ _______________ Fax:___________________________
Resident of the City of Fremont: __23_______ years
Demographic Information:
Ethnicity:
□ American Indian or Alaskan Native □ Chinese
□ Black or African American □ White
□ Afghan □ Vietnamese
□ Mexican □ Filipino
X Indian □ Pakistani
□ Other Asian origin: ________________ (write-in optional) □ Other African origin: _______________ (write-in optional) □ Other Hispanic, Latino, or Spanish origin: __________ (write-in optional)
-2-
Gender:
□ Male □ Prefer to self-identify
X Female □ Prefer not to say
Language(s) Spoken: ___English, Hindi______
Background Information:
Why do you wish to serve as a member of this Board or Commission: As a resident of Fremont, and somebody who extensively uses the parks, courts, playgrounds, and other recreational facilities, I would like to be involved with the decision-making. I realized how fortunate I was to be less than 10 minutes walking distance from two parks and would love to see more of our residents have at least one park meet that criterion. Having filled Newark’s coffers by utilizing Silliman when my children were younger, I would love to see Fremont develop an athletic center with a pool, gym, weights, indoor athletic facilities.
____________________________________________________________________________
What would you bring by way of perspective or experience to this Board or Commission: I have served on the PTAs of all three public schools attended by my children. Before coming to CA I was a volunteer naturalist who gave presentations on nature (flora, fauna, geology, natural history) to the public and was also on the board of the Boulder County Nature Association. I would bring the “parent perspective”, the “nature perspective”, the end-user “recreation citizen” perspective, and now, the “senior citizen” perspective,
____________________________________________________________________________
Employment/Volunteer Information:
Please list any qualifications you feel would provide positive input to the work of the commission.
Organization: _______________________________________ Dates: ____________________
Location: ________________________________ Position(s): __________________________
Responsibilities/accomplishments: For the past 18 years I have been teaching science at the college and University level. While that demonstrates teaching, a strong aptitude for writing funding proposals and analyzing data, and organizational skills, I am not sure how much of that would transfer directly.
____________________________________________________________________________
-3-
Organization: MSJHS, Hopkins JH, Gomes Elem Dates: ___~2004 to ~2011_____
Location: __Fremont_________________ Position(s): ____Various roles, including President of the PTAs at these schools______
Responsibilities/accomplishments: ________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Organization: ___Gomes Elementary________ Dates: ____2000 to 2011______
Location: ___Fremont_________________ Position(s): ____Volunteer________
Responsibilities/accomplishments: Helped with reading, math, and science; also was a volunteer for Music for Minors and FAME
Organization: ____Boulder County Parks and Open Space Dates: __1994-2000
Location: ____Colorado______ Position(s): ____Volunteer Naturalist________
Responsibilities/accomplishments: Led programs for the public (schools, families, and senior groups) on natural history. Also co-authored a quarterly newsletter for children.
____________________________________________________________________________
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: ________________________________
____________________________________________________________________________
____________________________________________________________________________
-4-
Education Information:
Mayo Graduate School_________________PhD_____________Physics____________ 1992 Educational Institution Degree/Diploma Field Year
____________________________________________________________________________ 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.)
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
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) 284-4060.
Please sign and date your application and submit to the Office of the City Clerk.
Thank you.
__________________________________________ _____________________________ Signature Date