Clear Form
BOARD OR COMMISSION APPLICATION FORM
DATE: 6/27/24
Check one: New Appointment
Re-Appointment
NAME OF BOARD OR COMMISSION: CCRP
NAME: Keri Sullivan
HOME ADDRESS:
ZIP CODE: HOME PHONE WORK PHONE:
OCCUPATION: Property management EMAIL ADDRESS
HOW LONG HAVE YOU BEEN A RESIDENT OF THE CITY OF RICHMOND: offard on all of malife but the last syrs once maring Prom SF.
PLACE OF EMPLOYMENT:
REASONS FOR INTEREST IN APPOINTMENT:
I. view this appoitment as away togue back to the community. My lived experience 1s something, that I nave awais wanted to parn into a positive the ummutty gough compass on and deeper understanding. - neer thent g would have the chance to contribute until recently, Looking forward to this oppertunity.
FRATERNAL AND/OR CIVIC ORGANIZATIONS:
Washington Elementary PTA, Rich Ciry Rollers, Holistic Health Practioner BA Crimina Justice. currenty working on certfication for counseling and substance abuse treatment
REFERENCES (Minimum 5 - List Name, Address, Phone Number, and Email Address)
1. Sarah Shwarka.
2. Tania Rulido
3. Amy vancteve.
4. Vesto Maldonado
5. Ariana Garcia-
To the best of my knowledge the information provided is true and correct Keri< ullivan 6/27/24
Signature Date
Deliver or Mail to City Clerk Or Email to: [email protected] 450 Civic Center Plaza Print and Sign
Richmond, CA 94804
For Office Use Only: New Appointment: Reappointment • 1st 02nd • 3rd