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Student Municipal Representative Application

  1. STUDENT MUNICIPAL REPRESENTATIVE APPLICATION

  2. City of Green Logo

  3. STUDENT INFO

  4. Commissions - (Please rank by order of preference - 1 being most preferred)

  5. Are you a resident of GREEN?*

  6. PARENT/GUARDIAN INFO

  7. EMERGENCY CONTACT INFO

  8. EDUCATION

  9. Grade (Fall 2020)*

  10. REFERENCES

    Please list three references

  11. Reference 1

  12. Reference 2

  13. Reference 3

  14. MEMBERSHIP/SCHOOL ACTIVITIES/CIVIC EXPERIENCE/VOLUNTEER EXPERIENCE

  15. 1

  16. 2

  17. 3

  18. 4

  19. EMPLOYMENT INFORMATION (IF EMPLOYED)

  20. ESSAY (250-500 WORDS)

  21. PLEASE READ

  22. The term of appointment for each student selected to serve a term or terms as a Student Municipal Representative are established and stated at the time of their appointment. Student representatives will serve from September through May. Appointments do not carry over from year to year. Students may reapply each year for the same or different commission.

  23. Student commission members are required to attend all commission meetings and conduct him/herself in a professional manner. Missing more than two meetings or unprofessional conduct that is disruptive to the proceedings may be cause for dismissal from the program. Student representatives are encouraged to participate in meetings, but students are not a voting member of the commission.

  24. The City of Green does not discriminate on the basis of race, color, religion, national origin, gender, age, marital status, sexual orientation or status with regard to public assistance or disability in the admission or access to programs, services, activities or employment.

  25. The facts set forth in my application are true and complete. I understand that if appointed, false statements on this application shall be considered cause for dismissal. I authorize investigation of all statements and matters contained in this application which the City of Green may deem relevant to my appointment.

  26. BY SUBMITTING THIS APPLICATION:*

  27. Leave This Blank:

  28. This field is not part of the form submission.