PRINT FORM RECEIVED CLEAR FORM
Richmone CITY CLERKS OFFICE
CITY OF RICHMOND
Richmond Youth Countil Applitation
Date of Application: Check one: New Appointment
03/08/2023
Re-Appointment:
Applicant Name: Elena Velazquez
E-mail address:
Date of Birth: Age at date of application: Years living in Richmond:
Home Address (Street Address, City, and Zip Code):
Primary Phone: Secondary Phone (optional):
2023 MAR 13 CITY 07
Name of School (if applicable):
Work Experience / Volunteer Experience:
Bay Area Girls Club since 2013, The Latina Center participant of several programs since 2012, Participant at Boys & Girls Club 2022 Rosie Girls Summer Camp from Rosie the Riveter Trust, completed Urban Tilth's 2022 Summer Apprentice Program, completed the NorCal First Alarm Fire Camp for girls in 2022 at the Oakland Fire Trainina Center, part of the vearbook Organizations, Honors, affiliations:
Bay Area Girls Club, The Latina Center, Urban Tilth, SIS Women's Day volu Bay Area Girls Club, The Latina Center, Urban Tilth, SIS Women's Day volu References (List Name, Address, Phone Number, and Email Address):
1)
2)I
3) N
To the best of my knowledge the information provided is true and correct:
Signature: Date: March 8th 2023
Submit to: City Clerk, 450 Civic Center Plaza, Richmond, CA 94804 OR Email to: [email protected] For Office Use Only: New Appointment: Reappointment: 0 1st •2"d M3rd Bay Area Girls Club since 2013, The Latina Center participant of several programs since 2012, Participant at Boys & Girls Club 2022 Rosie Girls Summer Camp from Rosie the Riveter Trust, completed Urban • Tilth's 2022 Summer Apprentice Program, completed the NorCal First Alarm Fire Camp for girls in 2022 at the Oakland Fire Training Center, part of the yearbook club and part of the Student Government Body. Volunteered for the SIS women day event since the age of 7. Completed the SUN Leadership Institute 2022.