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 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 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:*
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. Home Phone
22. Work Phone
24. Email Address
25. Occupation
27. Employer / Business
29. Business Address
31. City
32. State
33. Zip Code
35. Education
39. Qualifications:
41. 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.

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

    1. Yes
    2. No
45. 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.

47. Are you a Modesto resident?

    1. Yes
    2. No
48. If yes, what was the date of residency?
    If yes, what was the date of residency?
50. 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.

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

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

    1. Yes
    2. No
55. 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.

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

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

    —

    Inclusive dates: End Date
61. 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
63. If yes, please explain:
65. List relevant employment, training, and experience, certificates of training, licenses, and professional registration.
67. 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)
69. If other, please specify:
71. Describe your involvement in community activities and civic organizations. (Do not list partisan political parties.)
73. What is it about this position that interests you?
75. What qualities, experience, and expertise would you bring to it?
79. 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.

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

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

    1. Yes
    2. No
90. Why do you want to serve on the Youth Commission?*
92. What do you see as the primary issues currently impacting youth in our community?*
94. What skills and talents will you bring to the Commission?*
96. What other clubs and extra curriculars are you involved in?*
98. a. How many hours a week do you spend in these activities?*
99. b. How will you prioritize your involvement in this role?*
101. What do you enjoy doing with your free time?*
103. 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.

105. 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.
107. 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:


109. 1. Receive an email copy of this form.
110. Email address

     This field is not part of the form submission.

111. Submit

* indicates a required field