Application - Schwartz, Carole ESC 12-14-21 (2)C1'1'Y UrA'''LAN 11C IiLA(:H
BOARD / COMMITTEE MEMBER APPLICATION FORM
Please check ('1) the box beside each Board or Committee for which you are applying.
❑ Board Member Review Committee (BMRC)
❑ Cultural Arts & Recreation Advisory Committee (CARAC)
O Pension Board of Trustees (PBOT) — Police
DATE: EQC ) ao-(
APPLICANT'S INFORMATION:
FIRST NAME: 0-0--1-01e-
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❑ ommunity Development Board (CDB)
E Environmental Stewardship Committee (ESC)
❑ Pension Board of Trustees (PBOT) - General
LAST NAME:
ADDRESS: ` e (-Lit --11^-.�►
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CELL PHONE: at 0 t' (— t 33 HOME PHONE:
PRECINCT/DISTRICT: 13 ()A7- E-MAIL ADDRESS: ma -S. E p r
Please explain any employment experience, board/committee experience, and/or community volunteer experience
relative to the board/committee applying for.
Please provide a brief explanation of your interest and your reasons for wishing to be appointed to this
board/committee.
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PLEASE NOTE: This application will expire two (2) years after date of submittal.
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Please return completed form to
Donna L. Bartle, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233
Rev. 2-13-20 Page 1 of 2