RECEIVED
PRINT FORM OCT = 2 2024 CLEAR FORM
CITY OF RICHMOND
CITY CLERK'S OFFICE
Richmond Youth Council Application
Date of Application: Check one: New Appointment:
9/30/24
Re-Appointment:
Applicant Name Scarlett Perez
E-mail address:
Date of Birth: Age at date of application: 16 Years living in Richmond:
16 Home Address (Street Address, City, and Zip Code):
94804
Primary Phone: Secondary Phone (optional):
Name of School (if applicable):
Work Experience / Volunteer Experience:
Organizations, Honors, affiliations:
References (List Name, Address, Phone Number, and Email Address):
1) Rhea Laughlin
2)Tomasa Espinoza,
3)Gabi Rivas,
To the best of my knowledge the information provided is true and correct:
Signature: vill Date: 9/30/24
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