RECEIVED
MAR 1 4 2024
PRINT FORM CLEAR FORM
CITY OF RICHMOND
CITY CLERK'S OFFICE
Richmond Youth Council Application
Date of Application: Check one: New Appointment:
03/07/2024
Re-Appointment:
Applicant Name:
valeria serrano
E-mail address:
Date of Birth: Age at date of application: Years living in Richmond: 15 15 Home Address (Street Address, City, and Zip Code):
Primary Phone: Secondary Phone (optional):
Name of School (if applicable):
Making waves Academy
Work Experience / Volunteer Experience:
volunteer: st cornelius community service (ions)
Organizations, Honors, affiliations:
Brain and Prychology club Treasurer
References (List Name, Address, Phone Number, and Email Address):
1) Stephany Guzman
To the best of my knowledge the information provided is true and correct:
Signature: Date: 03/07/2024
Submit to: City Clerk, 450 Civic Center Plaza, Richmond, CA 94804 OR Email to: [email protected] For Office Use Only: New Appointment: Reappointment