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Act, or any other applicable statie and federa� law, that in any �vay reIated to the dissemination to ihe public of <br />information contained in this app�ication that wauid be classifi�d as p�ivate under sucn laws. I understand �hat I <br />may contact the responsible authority for the City of Rosevil�� if I ha�e any questions regarding the public or <br />private nature of the infor�nation provided.: Yes <br />I understand ihat the City will not publish rny phone or fax numbers or eFnail address without my authorization <br />and do hereby allow the City to pub�ish {check all �hat apply).; Home telephone number <br />Daytime Phone: ' <br />Evening Phone: 651-486-5$06 <br />Ce�ll Phone: 612-94Q-3ll � <br />I-�ome �'hone� {if d�fferent}; <br />Work Phone {if different}: <br />Home Fax: <br />Work �'ax: ` ' <br />�Iome Email: <br />Work Email: <br />S#udent Application: �10 <br />If yes; please list your grade: <br />May we contact yau using your work einai� or fax?: Yes <br />I have read and understa�d the s#atements on this form, and � hereby sw�ar or af�rm that the staternents an this <br />form are true. : Yes <br />Additional Inforrnation_ <br />Form submiited on: 1/15/2009 4:21:07 PM <br />Submitted �rom IP Addres�s�: <br />Farm Address: http://www.ci.rosevalle.mn.us/forms.asp?F'ID=237 <br />