CAN Community Council Membership Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thanks for your interest in joining the Community Council. Once you have submitted your application, a member from CAN staff will let you know that your application has been received and your application will be presented to the Community Council for consideration of adding you as a new member.

Please note that we ask questions about race and city council district to ensure racial and geographical diversity and equity on the Community Council. We strive to mimic the full breadth of the community we represent.

If you have any questions please contact Jelina Tunstill, jtunstill@canatx.org.

Email *

Name *

Phone Number *

What is your race/ethnicity? You may mark only one box.

Hispanic or Latino: a person of Cuban, Mexican, Chicano, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

White (not Hispanic or Latino): a person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American (not Hispanic or Latino): a person having origins in any of the black racial groups of Africa.

Asian (not Hispanic or Latino): a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Native Hawaiian or Other Pacific Islander (not Hispanic or Latino): a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

American Indian or Alaska Native (not Hispanic or Latino): a person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.

Two or More Races (not Hispanic or Latino)

Prefer Not to Answer

What city council district do you live in? (Please specify the city i.e. Austin City Council District 1) *

What county precinct do you live in? (Please specify the county i.e. Travis County Precinct 1) *

Why are you interested in serving on the CAN Community Council? (Please limit response to 1500 characters) *

Please state your employment, volunteer organizations, or other community activities you are engaged in. State the title or role you fulfill in each. (Please limit response to 1500 characters) *

What specific interests, concerns, organizations, issues, and populations do you believe you can represent on the CAN Community Council? (Please limit response to 1500 characters) *

How will you go about communicating the information you learn through your service on the CAN Community Council to the various organizations, groups, and populations you are connected with? (Please limit response to 1500 characters) *

Please list 2 community references who can tell us about your community experience, include name, email, phone number, and how the person knows you. *

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms