2. First Name*
3. Last Name*
5. Home Street Address*
6. City*
7. Zip*
9. Email Address*
10. Phone Number
12. Employer
13. Position
15. Briefly describe your background and motivation for serving on the City of Marysville Diversity Advisory Committee*
    3,000 character limit (about 500 words)
17. Languages you speak other than English
19. Request for Accommodation. If you require an accommodation, please let us know what accommodation is needed for participation.
21. Minimum age for participation with the committee is 16 with parent or guardian authorization for participation if under 18. *

    1. I am over the age of 18
    2. I am 16 or 17 years old. If selected for participation with the Diversity Advisory Committee, my parent or guardian will sign an authorization for me to participate with the committee.
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23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

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