Advisory Board Commission Appointments

Board Appointments Application
Select Board, Commission or Committee

Pedestrian Advisory Committee (PAC)
Applicant Name

First NameLast Name
City of Residence
Current Occupation
Park District
Employer
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Describe your background related to any required or desirable qualification listed in the Appointment Notice. Include applicable experience with civic, professional or volunteer organizations and other city boards or commissions. List any awards or special recognition.
The information provided on this page is open to the public per the Minnesota Data Practices Act
Street Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home/Cell Phone Number

Area CodePhone Number
Work Phone

Area CodePhone Number
Email Address
example@example.com
Note: If appointed, Minnesota Statute 13.601 requires that a telephone number and/or an e-mail address where the appointment can be reached, and residential address will be considered public data.
List the reasons you want to serve on this body:
List the issues that you believe the committee should address:

List names, addresses and telephone numbers of no more than 3 references:

Please list any interest, directly or indirectly, in any purchase, sale, lease or contract to which the Minneapolis Park & Recreation Board is a party:
Typing your name into the box below will satisfy the requirements for a legal signature.
Demographic Information (Optional)

Minneapolis seeks to increase diversity on boards and commissions.Your answers on this form help us determine the success of our efforts. You areNOT required to provide this information, however your cooperation isappreciated and valued. This information is not used in determiningappointments to boards, commissions and committees and will be available to thepublic, if provided.
Race/Ethnicity, and/or Culture
Language(s) spoken athome:
Gender Identity:
Age: (please selectone)

Under 1818-2930-4445-6465 and older
Do you rent or own the place you live?

RentOwnOther
Please note that completed applications and additional application material that you provide may be subject to public information requests.

Appointments are subject to confirmation by the Minneapolis Park and Recreation Board President. One area of inquiry will be whether you or your spouse have a conflict of interest.

I will accept appointment if selected by the Minneapolis Park and Recreation Board. If appointed, I pledge my best efforts to resolve, before assumption of office, any conflicts of interest that would be inconsistent with my responsibilities as an MPRB appointee.
Should be Empty:

Board Appointments Application