HomeMy WebLinkAboutDenny Erickson Charter AppCity of Mounds View
2401 County Highway 10
Mounds View, MN 55112
763-717-4000
Application for Advisory Commissions and Committees
Group(s) applied for: C7 C.- a 6-� 60 I-kq kh lis I 0 1--1
Full Name (Please Print): 0 -&—kj, , 'S' Z- k" I C-1 '_7
Work Phone: / 2- �' �� 2 �.3 Work/Cell Phone:
Address: �L % 7 s TZ-- V ( -C r ("
Years at this address: 2 '_� Years you have lived in Mounds View:
E-mail Address:
Experience and Qualifications
Skills and Interests:
Employment, Occupation or Other Relevant Experience:
Memberships, Accomplishments or Other Qualifications:
Please state your reason for wanting to serve with this group://i /4
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Signature: Z'�-ep- � Date:
(Your response to any of the above inquiries may be continued on the back of this form and you
may attach other information that you would like the City Council to consider.)
The City of Mounds View is committed to the policy that all persons shall have access to its programs,
facilities and employment without regard for race, ethnicity, sex, age or physical abilities.