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2. Richmond Fund for Children and Youth Oversight Board Application
4. Please check all the boxes to indicate acknowledgment of the following statements:**

   1. I understand the responsibilities, powers, and functions of the Richmond Fund for Children and Youth Oversight Board and have reviewed the Department of Children and Youth webpage
   2. I am able to attend regular meetings of the Oversight Board which take place the first Monday of each month at 6:00 PM
   3. Participation on the Oversight Board may require filing of the Fair Political Practices Commission’s Statements of Economic Interest (Form 700). If necessary, I will comply with all filing obligations
6. By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.*

   1. I agree
8. To the best of my knowledge, the information that is provided is true and correct:
10. Name (First M. Last)*
12. Date (MM/DD/YYYY):*
14. Parent/Guardian (if under 18):
16. Name (First M. Last):*
18. Date (MM/DD/YYYY):*
20. Personal Information
22. Name:*
24. I am:*

    1. between the ages of 15 and 24

    1. over the age of 24
26. Date of Birth (MM/DD/YYYY):*
28. Home Address (Street Address, City, Zip Code):*
30. E-mail Address:*
32. Phone:*
34. How long have you been a resident of the City of Richmond or North Richmond?**
36. Are you a parent of Richmond youth?*

    1. Yes

    1. No
38. What gender do you identify as?*
40. What ethnic/racial identity do you identify as? (Include one or more if applicable)*
42. What is your primary language?*
44. What other languages do you speak?*
46. List any organization, club, or association you currently participate in and/or are a member of. Please specify if you serve as a current Board member or hold a leadership position:*
48. Employment and Education

    Note: Having work or educational experience is not required to join the Oversight Board.

50. Employer:*
52. Occupation:*
54. Employer Address (Street Address, City, Zip Code):*
56. Please list current school and/or prior education:*
58. Questions

    Note: Each of the following questions has a maximum amount of words that is allowed. Any words beyond the maximum amount allowed will not be taken into consideration. It is recommended to type your answers into a word processing program like Microsoft Word or Mac Pages, and then copy and paste your answers into the areas below.

60. 1. Please state why are interested in serving as a member of the Oversight Board*
62. 2. Please state your vision for youth in Richmond*
64. 3. According to Measure E, below are eligible uses for the Richmond Fund for Children and Youth. If applicable, please mark one or more of the areas below that you have expertise or work/volunteer experience in:

    1. Violence Prevention and Response
    2. Education and Job Training
    3. Parent/Guardian Support
    4. Media, Arts, Culture and Technology
    5. Youth and Family Leadership, Organizing and Civic Engagement
    6. Health and Well-Being
    7. Environmental Health and Justice
    8. Outdoor Education and Recreation
    9. Deportation Support: Support for young people and families experiencing or being threatened with deportation
66. 4. Based on or in addition to the areas marked above, please list or expand on applicable skills and/or experience that you can bring to the Oversight Board (e.g. experience with eligible uses as listed above, strategic planning, financial management, youth organizing, teamwork, working with underserved populations, etc.)
68. 5. Is there any additional information that you would like to share? If so, please list the information below
70. References (Optional)

    List name, email, phone number and relationship (e.g. teacher, coach, employer, mentor, etc.):

72. Reference #1
74. Reference #2
76. Reference #3
Leave This Blank:


78. 1. Receive an email copy of this form.
79. Email address

    This field is not part of the form submission.

80. Submit

* indicates a required field