Committee Application
Please join us by filling out and returning a committee member application.
Name *
Your answer
Address *
Your answer
City *
Your answer
State/Province *
Your answer
ZIP/Postal Code *
Your answer
Country *
Your answer
Phone Number *
Your answer
Email *
Your answer
Years of Residency in the Village of Hempstead *
Your answer
Family Size *
Your answer
Education (Please indicate the highest level of academic achievement) *
Your answer
Committee you are interested in *
Your answer
Tell us about yourself and why you are interested in serving on the committee you selected. *
Your answer
Have you ever experienced economic hardship now or in the past? Briefly describe. *
Your answer
Please share how you believe your participation in this committee will contribute to the decision making process of the initiative (whether it is based on your own personal experience or working with other people in poverty.) *
Your answer
By signing below you understand and acknowledge the 1-year commitment you are undertaking should you be selected as a Village of Hempstead ESPRI Initiative Committee Member. If you are not selected to be part of a committee, please make sure to let us know in what way you would like to participate whether it is through community forums, listening sessions or one-on-one interviews. Please type your name below and date. *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.