RECEIVED
OCT = 1 2024
PRINT FORM Biolen CLEAR FORM
CITY OF RICHMOND
CITY CLERK'S OFFICE
Richmond Youth Council Application
Date of Application: Check one: New Appointment
September 30th 2024
Re-Appointment:
Applicant Name:
Valeria Serrano
E-mail address:
Date of Birth:
Age at date of application: /byry Years living in Richmond: Joyrs Home Address (Street Address, City, and Zip Code):
Richmond, CA 94801
Primary Phone: Secondary Phone (optional):
Name of School (if applicable):
Work Experience / Volunteer Experience:
• Experience: 1yr Richmond Youth Council
• Volunteer: St. Cornelius Community Service lyrs
Organizations, Honors, affiliations:
•Brain and Psychology Club: Vice President
References (List Name, Address, Phone Number, and Email Address):
1).
3)
To the best of my knowledge the information provided is true and correct:
Signature: Date: 09-30 - 2024
Submit to: City Clerk, 450 Civic Center Plaza, Richmond, CA 94804 OR Email to: [email protected] For Office Use Only: New Appointment: Reappointment: 0OIst 02 0 3rd