RECEIVED Harleman
CITY CLERKS OFFICE
CITY OF RICHMOND
BOARD OR COMMISSION APPLICATION FORM
2022 MAR -2 AMII: 01
DATE: 1-31-22
Check one: New Appointment
Re-Appointment
NAME OF BOARD OR COMMISSION: Richmond Commission on Aging NAME: Michelle Hayes
HOME ADDRESS:
ZIP CODE: 94804 HOME PHONE: WORK PHONE:
OCCUPATION: retired EMAIL ADDRESS: [email protected] HOW LONG HAVE YOU BEEN A RESIDENT OF THE CITY OF RICHMOND: 10 years PLACE OF EMPLOYMENT: n/a
REASONS FOR INTEREST IN APPOINTMENT:
Continuing the good works of the Commission; helping and advocating for our older adult community.
FRATERNAL AND/OR CIVIC ORGANIZATIONS:
Park Plaza Neighborhood Council; Faith in Action/East Bay; California Poor Peoples' Campaign EDUCATION:
M.S. degree, Human Resources, Organizational Development, University of San Francisco B.A.degree, Pol.Science, S.F.StateUniversity
REFERENCES (Minimum 5 - List Name, Address, Phone Number, and Email Address)
1. Kiran Agarwal, 1
2. Steve Lipson
3. Myrtle Braxton
4. Lesa Vaughn
5. Diane Blackmon 4
To the best of my knowledge the information provided is true and correct:
chelle f. Hages 1-31-22
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