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100104_Packet
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100104_Packet
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10/12/2012 3:29:08 PM
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12/31/2009 3:32:41 PM
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How lias your view of the role af this Convnission changcd sutce your first term? <br />�p. <br />Other Co�nments: (I��chrde any fi�r•tlzer inforn�atiarz yoic wo2�ld like tlze City Coz�ncil to consider or <br />thcat yoti feel is relevant to re- appoifzlrne��t, You tnay also attach otl�er rnaterials yoar wocrld like the <br />Cotrncil to consicier.) <br />7'eruicsseu �Vi�r»in� - Some or all ttie information ihat you are asked to provldc is classified by Stale Ea`v as eit}�cr private or <br />confidcutial. 1'rivatc data is iuformalion tliat generaliy cauvot be given to ihe public Utit can be given to the suhject of t}�e data. <br />Confidenlial ciata is inforu�atioii t�iat generally cannot be given to either the pubiic or the svbject of tlle data. <br />"�'hc City of Roseville is coflecti�ig the infonnation to deterniiuc qualifi.cations to serve on a. Citizeu Advisory Cominission. <br />Yoii ar� nc�t Icgally required tn provide 1Iiis infonnalion. Hnwever, if you do not supply lhe iaiforu�ation, you may not serve on <br />a Citilen lldvisory Cotttmistii�n, <br />Uthcr persons or entities authc�rizcd Uy law to receive this iniorntatiou are City CounciI members, staff, residents of Rnsevi]le <br />and interested otiiers. <br />I undei-stand that all informatton provided u1 tlus application, exceJ�t my telepho�le nwnbers, fax nu�nber and <br />email address, may be distribtited by the City ta the ��ublic ulcluding, but not fimited to, b�ing posted o�l t}ie <br />City of 17oseville websit�. I agree to waive any and all clai.ms under the Nlinnesota Governn�ent Dat�i <br />Practices Act, or any other applica�le state ��d fedet•al ]aw, that u� any way t�elated to tl�c dissenunation to tlte <br />�ublic of iilfonnatiot� co�ltained in th.is applica#ion tl�at would be cfassified as privafe tir-►der such Iaws. 1 <br />�ln<lerstand that I�n�y contact the i-esponsi�ile authority for the City of Roseville if � have a�ly quc;stions <br />i'egarding t�ie public or private nature of the information provided. <br />f undez�stand dlat the City will �iot publisl� �ny pllone or fax numbers a�� email address without iny authorization <br />atici do Iaet-eby allo�v tlle City to publisii (check all tl�at appfy). <br />�3omc tclepho3�e ilumber <br />.__._��ork teiepha3�e ni�mber <br />/�aome ema[l address <br />�tivoik email add � • <br />��- <br />Signature of Ap�Iicat�t <br />ReappoiiNmen( i(pplicn�i0n 09I130 <br />I�. �-� � <br />Date of Application <br />
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