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Lead-Safe Advisory Committee Application
Name:
Home Mailing Address:
Home Physical Address:
Phone:
Email:
Education:
Sector: Academic Advocacy Government Nonprofit Philanthropy Private Other
Current Employer:
Current Position:
Please describe your training, experience, and/or qualifications related to serving on a board/committee:
Why are you interested in serving on the Lead-Safe Advisory Committee?
Do you currently serve on a City of Milwaukee board, committee, or task force?
If yes, please describe:
Have you served on a City of Milwaukee board, committee, or task force in the past?
If yes, please describe:
Do you currently work for an entity or agency that either receives funding from or has a contract with the City of Milwaukee to perform services?
If yes, please describe:
Do any of your immediate family members (e.g. spouse, partner, child, etc.), currently serve as an officer, director, or partner in any entity or agency that receives funding from, or has a contract with the City of Milwaukee?
If yes, Please describe: