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Neighborhood Council Name:
Date:
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***Highlight and BOLD all changes in yellow and include a small summary of changes***Please feel free to download this template (File>Download>.xlsx or .csv) and use it for roster submissions. Thank you!These fields are for secondary ways of contacting board members if we cannot reach them through their Official NC email address. This information is for INTERNAL USE ONLY and will NOT BE PUBLIC.
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First NameLast NameBoard SeatTerm Expiration
Date
Executive Officer Youth/Student Rep 14-17 years old (Mark "X")Homelessness Liaison (Mark "X")Appointed Regional Grievance Liaison
(Mark "X")
Appointed CIS Filer (Community Impact Statement Filer)
("Mark "X")
Official Neighborhood Council Email AddressPrivate Email AddressPhone Number 1Phone Number 2AddressNotes
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Board Members Removed (if any)
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First NameLast NameBoard Seat removed from
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When you are done, please download the file (File>Download>.xlsx) and send it to rosters@empowerla.org
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