Application for Boards, Commissions & Committees

2. Title II Compliance
   In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of Modesto (“City”) will not discriminate against individuals on the basis of disability in the City’s services, programs, or activities. For more information, please visit the City of Modesto website.
4. Apply To:*
   -- Select One --Airport Advisory CommitteeAudit CommitteeBlight Abatement Advisory CommitteeBoard of Building AppealsBoard of Zoning AdjustmentCharter Review CommissionCitizens Districting CommissionCitizens Housing & Community Development CommitteeCitizens' Transportation Sales Tax CommissionCulture CommissionDisabled Access Appeals BoardDowntown Improvement District Advisory BoardEntertainment CommissionEquity CommissionGolf Courses Advisory CommitteeHousing Rehabilitation Loan CommitteeHuman Relations CommissionLandmark Preservation CommissionPlanning CommissionSalary Setting CommissionTuolumne River Regional Park Citizens Advisory CommitteeTuolumne River Regional Park JPAYouth CommissionOther (Please Specify)
6. If other, please specify:*

   Note: The application period for the Community Police Review Board ended on January 31st, 2023. The Measure H Oversight board application period ended March 24th, 2023. 

8. First Name
9. Last Name
11. Date of Birth*
    Date of Birth
12. School*
13. Grade*
15. Address
17. City
18. State
19. Zip Code
21. What Council District do you live in?
    -- Select One --District 1District 2District 3District 4District 5District 6
23. Home Phone
24. Work Phone
26. Email Address
27. Occupation
29. Employer / Business
31. Business Address
33. City
34. State
35. Zip Code
37. Education
41. Qualifications:
43. Are you a retired Stanislaus County judge?*

    1. Yes
    2. No
45. Are you a member from a bona fide local taxpayer's association with tax exempt status under the relevant provisions of the Internal Revenue Code?*

    1. Yes
    2. No
47. Are you a member from a bona fide local nonpartisan political organization, with tax-exempt status under Section 501(c)(3) of the Internal Revenue Code, dedicated to encouraging informed and active participation in government?*

    1. Yes
    2. No
49. Are you a member from a former Civil Grand Jury who has served in that role within in the previous five years?*

    1. Yes
    2. No
51. Do you consider yourself to have demonstrated civic involvement and a capacity to serve in an honest, independent, and impartial fashion?*

    1. Yes
    2. No
53. Are you a member of any of these groups?*

    Check all that apply. 

    1. No, I am not a member of these groups.
    2. Schools
    3. Local Trade Associations
    4. Chambers of Commerce
    5. Nonprofit Organizations

    1. Senior Citizens Groups
    2. Non-partisan Political Organizations
    3. Tax-payer Associations
    4. Neighborhood Organizations
55. If so, please list the names of the groups you are a member of:*
57. Past Lobbyist Disqualification*

    1. I understand that I am unable to apply for this committee if I am or have been a lobbyist.

    If you do not meet at least one of the qualifications for the committee or commission you wish to apply for, your application may be rejected. Please review our other committees and commissions and apply for another that meets your interests or skillset.

59. Are you now or have you ever been a lobbyist?*

    1. Yes
    2. No
60. Add inclusive date range:
    Add inclusive date range: Start Date

    —

    Add inclusive date range: End Date
62. Economic Interest Disqualification*

    1. I understand that I must not have economic financial interest with the City of Modesto to apply for this committee.

    If you do not meet at least one of the qualifications for the committee or commission you wish to apply for, your application may be rejected. Please review our other committees and commissions and apply for another that meets your interests or skillset.

64. Have you done business with the City that represents an economic interest?*

    1. Yes
    2. No
65. Add inclusive date range:
    Add inclusive date range: Start Date

    —

    Add inclusive date range: End Date
67. Are you an active Certified Public Accountant (CPA)?*

    1. Yes
    2. No
69. Financial Accounting or Performance Auditing Experience Requirement*

    1. I understand that I must have at least 2 years in financial or performance auditing to apply for this committee.

    If you do not meet at least one of the qualifications for the committee or commission you wish to apply for, your application may be rejected. Please review our other committees and commissions and apply for another that meets your interests or skillset.

71. Do you have two (2) or more years’ experience in financial or performance auditing?

    1. Yes
    2. No
73. Full-time Highschool Enrollment Requirement*

    1. I understand that I must be enrolled full-time in High School in order to apply for this committee or commission.

    If you do not meet at least one of the qualifications for the committee or commission you wish to apply for, your application may be rejected. Please review our other committees and commissions and apply for another that meets your interests or skillset.

75. Are you enrolled full-time in high school?*

    1. Yes
    2. No
77. Modesto Resident Requirement*

    1. I understand that I must be a Modesto resident in order to apply for this committee or commission.

    If you do not meet at least one of the qualifications for the committee or commission you wish to apply for, your application may be rejected. Please review our other committees and commissions and apply for another that meets your interests or skillset.

79. Are you a Modesto resident?*

    1. Yes
    2. No
80. If yes, what was the date of residency?
    If yes, what was the date of residency?
82. Registered Voter Requirement*

    1. I understand that I must be a registered voter in the City of Modesto to apply for this committee or commission.

    If you do not meet at least one of the qualifications for the committee or commission you wish to apply for, your application may be rejected. Please review our other committees and commissions and apply for another that meets your interests or skillset.

84. Are you a registered voter in the City of Modesto?

    1. Yes
    2. No
85. Are you a registered voter in Stanislaus County?

    1. Yes
    2. No
87. Employment Disqualification*

    1. I understand that I cannot be employed by the City of Modesto or Stanislaus County and serve on this commission or committee.

    If you do not meet at least one of the qualifications for the committee or commission you wish to apply for, your application may be rejected. Please review our other committees and commissions and apply for another that meets your interests or skillset.

89. Are you now or have you ever been employed by the City of Modesto?*

    1. Yes
    2. No
90. If yes, in what capacity?
91. Inclusive dates:
    Inclusive dates: Start Date

    —

    Inclusive dates: End Date
93. Relative Disqualification*

    1. I understand that I am unable to apply for this committee if I am a relative by blood or marriage to the third degree of the mayor, member of the Council, any Charter Officer, or any department head.

    If you do not meet at least one of the qualifications for the committee or commission you wish to apply for, your application may be rejected. Please review our other committees and commissions and apply for another that meets your interests or skillset.

95. Are you a relative by blood or marriage to the third degree of the mayor, member of the Council, any Charter Officer, or any department head or deputy department head?*

    1. Yes
    2. No
97. Do you have relatives or a member of your household who are employed by the City of Modesto, or who are currently serving on the City Council, or who are Board members or Commissioners?

    1. Yes
    2. No
99. If yes, please explain:
101. List relevant employment, training, and experience, certificates of training, licenses, and professional registration.
103. How did you learn about the board for which you are applying?

     1. Community Group
     2. Newspaper
     3. Place of Employment
     4. Utility Bill Insert
     5. Other (Please specify)
105. If other, please specify:
107. Describe your involvement in community activities and civic organizations. (Do not list partisan political parties.)
109. What is it about this position that interests you?
111. What qualities, experience, and expertise would you bring to it?
115. Demographics

     City of Modesto invites all applicants to voluntarily self-identify their gender, race/ethnicity, veteran status and disability. Submission of this information is voluntary and refusal to provide will not affect the application process. The information will be kept confidential and will only be used in accordance with the provisions of applicable laws, executive orders and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement.

117. Gender
     -- Select One --FemaleMaleNon-Binary
118. Ethnicity
     -- Select One --African-AmericanAmerican Indian/ Alaskan NativeAsianHispanic or LatinoNative Hawaiian or other Pacific IslanderWhiteTwo or more races
120. Are you currently, or have you ever, served in the Armed Forces?

     1. Yes
     2. No
122. Do you consider yourself disabled?

     1. Yes
     2. No
126. Why do you want to serve on the Youth Commission?*
128. What do you see as the primary issues currently impacting youth in our community?*
130. What skills and talents will you bring to the Commission?*
132. What other clubs and extra curriculars are you involved in?*
134. a. How many hours a week do you spend in these activities?*
135. b. How will you prioritize your involvement in this role?*
137. What do you enjoy doing with your free time?*
139. Are you able to meet the time and travel commitments of approximately three to four hours per month that come as a member of this commission?*

     1. Yes
     2. No

     Regular general meetings are held on the 3rd Thursday of the month 4:00 p.m. at the Neighborhood Center at Marshall Park located at 420 Chicago Avenue, Building A, Modesto, CA 95351. 

     Note: To stay apprised of youth issues in Modesto, attendance at other meetings, such as City Council and other City boards and commissions, will be encouraged.

141. Applicant Acknowledgement*

     1. If selected, I commit to attending all my meetings and serving diligently to represent the youth of Modesto on the Youth Commission.
143. Parent / Guardian Acknowledgement *

     1. If selected, I commit to attending all my meetings and serving diligently to represent the youth of Modesto on the Youth Commission.
Leave This Blank:


145. 1. Receive an email copy of this form.
146. Email address

     This field is not part of the form submission.

147. Submit

* indicates a required field