Outside Agency Program - Committee Application

2. Outside Agency Program Committee
   The Wheat Ridge City Council is seeking volunteers to participate on the Outside Agency Program Committee to review and recommend funding allocations for the Outside Agency Program.

   The Wheat Ridge City Council is seeking volunteers to participate on the Outside Agency Program Committee to review and recommend funding allocations for the Outside Agency Program.

4. One Wheat Ridge resident will be chosen from each City Council District to serve on the Committee for a two-year budget cycle term (2021 & 2022) to expire July 2022.

   One Wheat Ridge resident will be chosen from each City Council District to serve on the Committee for a two-year budget cycle term (2021 & 2022) to expire July 2022.

8. Contact Information

10. First Name

11. Last Name

13. Address1

15. Address2

17. City

18. State

19. Zip

21. Email*

22. Phone Number*

23. I live in District:*
    -- Select One --IIIIIIIV

27. Why do you want to serve on the Outside Agency Program Committee?*

29. Can you foresee any conflicts of interest you may have with the outside agencies that may apply? (i.e. working at or serving on a board or non-profit)*

    1. Yes

    1. No

31. If yes, please explain:

33. To be considered for the Outside Agency Program Committee, you will need to attend the application review presentations in 2021.

35. Are you able to attend ALL of the following dates: May 18 & 25 and June 8 & 15?*

    1. Yes

    1. No

    *At this time, all Outside Agency Presentations are anticipated to take place virtually.

39. Verification: Please check box*

    1. I am requesting appointment as a member of the Outside Agency Program Committee. If appointed, I hereby commit to the best of my ability to fulfill the role for a two year term until July 2022.

41. All qualified candidates will be contacted directly regarding next steps.
    Applications are due by Friday, April 30, 2021 at 11:59 p.m.

    Applications are due by Friday, April 30, 2021 at 11:59 p.m.

Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

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