PRINT FORM CLEAR FORM
Richmond Youth Counc1?4 Blication
Date of Application: Check one: New Appointment:
2/26/24
Re-Appointment:
Applicant Name: Scarlett Perez
E-mail address:
Date of Birth: Years living in Richmond:
12/19/2007 Age at date of application: 16 16
Home Address (Street Address, City, and Zip Code):
Primary Phone: Secondary Phone (optional):
Name of School (if applicable):
Work Experience / Volunteer Experience:
RECEIVED
CITY CLERKS OFFICE
CITY OF RICHNOND
2024 FEB 27 PM0115
Organizations, Honors, affiliations:
References (List Name, Address, Phone Number, and Email Address):
To the best of my knowledge the information provided is true and correct:
Signature: Date: 2/26/24
Submit to: City Clerk, 450 Civic Center Plaza, Richmond, CA 94804 OR Email to: [email protected] For Office Use Only: New Appointment: Reappointment: • 1st • 2nd • 3rd