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MI What i s Your view of the role of this Cum nfisslon/Comnlittee/Task Force? LI Other Comments-, (Include anyfurthei- biforinatloii you would' like the City Council to consider or teat ,yotifeel is relevant to the appointinentyou ai-e seeking. You nzay also attach oth.er mater -rats you. would like Me Council to consider.) R W'J iii . e�ffl I i FA 0 Me= T'ennesse'e Warning - Some or all the information that you are asked, to provide i8 classified by State law as either private or confidential. Private data is information that generally cannot be given to the public but can be given to the subject of the data, Confidential data is information that generally cannot be given to either the public or the subject of the data. The City of Roseville is collecting the information to determine qualifications to serve on a Citizen Advisory Commission. You are not legally required to provide this information. However,, if you do not supply the information, you may not serve on a Citizen Advisory Commission. I understand that all information provided in this application) except my telephone numbers, fax number and email address, may, be distributed by the City to the public including,, but not limited to, being posted on the City of Roseville website., I agree to waive any and, all claims under the Minnesota Gave mgent Data Practices Act, or any other applicable state and federal law, that m* any way related to the dissemination to the public of infon-nation contained in this application that would be. classified as private under such laws. I understand that I may contact the responsible authority for the City of Roseville 'if I have any questions regarding the public or private nature of the information pirovidied. I understand that the City will not publish any phone or fax numbers or email address without my authorization and do hereby allow the City, to publish (checl- all that apply). home telephone number work telephone number other telephone number -J" me fax number, work fax number home email address, work email address 19 S' nature of Applicant Application 061'112'9 ra- rat