Rep. Ramirez's 4th District Advisory Committee Application Form
Thank you for your interest in collaborating with our office and applying to be a member of our Advisory Committees.

Rep. Ramirez is creating Advisory Committees to work with community stakeholders, to identify and provide input on key issues that impact the community, and to develop possible solutions. We are accepting applications until Thursday, December 31, 2020 .

Please fill out the form below to apply for a 4th District Advisory Committee. If you wish to nominate someone instead of applying for yourself, you may do so by filling out the Nomination Form: https://forms.gle/X8ohirVPy32TGokP9
Email address *
My Name: *
My Address: *
My Phone Number: *
My Email Address:
I am currently a resident of the 4th District: *
Which District Advisory committee/committees are you applying for? *
Justice Reform and Community Safety
Housing & Homelessness
Education and child welfare
Healthcare and mental health
Economic development and small business
No Preference
First Choice
Second Choice
Tell us about yourself: Please share a bit about your educational or professional background and your work in the community. Please also specify any relevant experience (personal, professional, or lived) that you have with the issue area.
Please tell us why you are interested in serving in this role?
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