Steering Committee Application
Please note - The selection of new steering committee members will be the decision of the current committee. The decision will be based on the questionnaire and will seek to provide the most diverse group of candidates possible, in terms of skills, interests, experience, geography, race/ethnicity and other demographics. Thank you for your time and for your desire to get involved! We will contact you after reviewing this questionnaire. Deadline for submission is September 15th, 2017.

*Information is being collected because Hartford Decide$ seeks to provide the most diverse committee in terms of skills, interests, experience, geography, race/ethnicity and other demographics.

Name
Your answer
Age
Home Address
Street address, City, State, Zip (i.e. 500 Main St, Hartford, CT, 06103)
Your answer
Home Phone
Your answer
Work Phone
Your answer
Mobile Phone
Your answer
Email
Your answer
I am best reached at:
Race/Ethnicity
Your answer
Employer
Your answer
Position
Your answer
If an NRZ has asked you to represent them on the Steering Committee, please write the name below:
Your answer
Do you speak any language(s) other than english?
Please list all special interests, skills, or hobbies:
Your answer
Please list any boards, committees, or interest groups on which you participate, or other community involvement:
Your answer
Which neighborhood(s) do you live/work in?
Your answer
Please explain why you would like to volunteer to be on the Hartford Decide$ Steering Committee and any special skills or experience you can contribute to the team:
Your answer
Please use this space to share your personal story or interest with regard to community engagement:
Your answer
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