BOARD OR COMMISSION APPLICATION FORM
DATE: _____________________
Check one: New Appointment
Re-Appointment
NAME OF BOARD OR COMMISSION: _____________________________________________________________ NAME: ______________________________________________________________________________________ HOME ADDRESS: ____________________________________________________________ ZIP CODE: ____________HOME PHONE: _____ WORK PHONE: _______________________ OCCUPATION: _______________________________________ EMAIL ADDRESS: ________________________ HOW LONG HAVE YOU BEEN A RESIDENT OF THE CITY OF RICHMOND: _____________________________ PLACE OF EMPLOYMENT: _____________________________________________________________________ REASONS FOR INTEREST IN APPOINTMENT:
____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ FRATERNAL AND/OR CIVIC ORGANIZATIONS:
____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ EDUCATION:
____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ REFERENCES (Minimum 5 – List Name, Address, Phone Number, and Email Address)
1._____________________ __
2.____________________ _________
3._______________ _________________
4._________________ _____________
5.___________________________ _________
To the best of my knowledge the information provided is true and correct:
_______________________________________________ ____________________________ Signature Date
Deliver or Mail to: City Clerk Or Email to: [email protected] 450 Civic Center Plaza
Richmond, CA 94804
For Office Use Only: New Appointment:
Reappointment:
1st
2nd
3rd
06/15/2021
✔
Economic Development Commission
Daniel Nathan-Heiss
.
94804
Professional Fundraiser & Business Consultant [email protected] 1 Month
Heiss Consulting Group & Phi Kappa Sigma Educational Fund Everywhere I have lived, I have made a point to get involved. That involvement began in Los Angeles as a member of Mayor Eric Garcetti's Crisis Response Team. I have also volunteered time to the cities of Pullman, WA, Washington, D.C., Riverside, CA, and Oakland. I hope to serve the city I now call home as best I can.
Los Angeles Mayor's Crisis Response Team, Phi Kappa Sigma Fraternity, CASE (Council for the Advancement and Support of Education), NAADD (National Association of Athletics Development Directors)
Georgetown University - Master's Degree - Sports Business, Finance, & Economics - 2015 Washington State University - Bachelor's Degree - Communication - 2009 Madeline McComb,
Kimberly Perplies,
Evan Epstein,
Brandon Young,
Eric Perlmutter-Gumbiner,
06-15-21