RECEIVED
CITY CLERKS OFFICE
CITY OF RICHMOND
PRINT FORM CLEAR FORM
2023 AUG 24 PM 4: 14
Richmond Youth Council Application
Date of Application. Check one: New Appointment
08/23/2023
Re-Appointment:
Applicant Name:
Jocelyn Nichole Hernandez Trueba
E-mail address:
Date of Birth: Age at date of application: 17 Years living in Richmond:
08/23/2023 6
Home Address (Street Address, City, and Zip Code):
246 First st, Richmond, California, 94801
Primary Phone: Secondary Phone (optional):
Name of School (if applicable):
Work Experience / Volunteer Experience:
I have tabled for events and have joined community workshops with Reimagine Richmond Organizations, Honors, affiliations:
Reimagine Richmond
Reimagine Richmond
Leadership Class President (Newly Elected)
References (List Name, Address, Phone Number, and Email Address):
1) Jackelyn Avendano Mendez,
2Chrstian Vuzil
3) Carmen Martines
To the best of my knowledge the information provided is true and correct:
Signature: AS Date: 8-23-2023
Submit to: City Clerk, 450 Civic Center Plaza, Richmond, CA 94804 OR Email to: [email protected] For Office Use Oniy New Appointment Reappointment