2. 
4. Application for Consideration of Appointment Senior Services Advisory Committee
6. The Public Information Act (PIA) may allow for public review of this application upon request
   
   
   Qualifications for the Senior Services Advisory Committee:
   Members must be at least 55 years of age, or have relative experience in providing services to seniors, should be persons who are concerned about senior affairs in the community, and must reside within the City.
   
   Functions:
   1. The Senior Services Advisory Committee shall act as an advisory body to the City Manager and City Council and shall:
   
   a. recommend the role of the City and the Committee in ensuring the provision of services to the elderly;
   b. advise City Council as requested on elderly issues;
   c. assist the City in identifying programs for the elderly that are needed in the community; and
   d. perform other duties assigned by City Council;
   
   2. The City Manager shall designate staff liaison responsibilities to the Committee.
   
   Term of Office: Two years
   Number of Members: Thirteen members
   Meeting Time & Place: At least once a month, or at the call of the chair, at City Hall
   Established by: Ordinance No. 2018-32
   
   A public notice will be announced to accept applications no less than 30 days prior to the date of regular board appointments, and no less than 14 days in the case of a vacancy.
   
8. Is this a New Application or a Re-appoinment Application?*

   1. New Application
   2. Re-appointment Application
10. Personal Information
12. Personal Information

    1. Mr.
    2. Dr.
    3. Ms.
    4. Mrs.
    5. Other
14. First Name
15. Last Name
17. Address:
19. City
20. State
21. Zip
23. Mailing Address: (if different)
25. City
26. State
27. Zip
29. Phone Number (Home)
30. Phone Number (Business)
32. Fax Number (Home)
33. Fax Number (Business)
35. Email Address
37. Are you a qualified voter in the city of Kerrville?

    1. Yes
    2. No
39. Do you live inside the city limits of Kerrville? *

    1. Yes
    2. No
41. How Long?
43. Employment
45. Employer Name:
47. Employer Address:
49. Occupation:
51. Business Address:
53. City
54. State
55. Zip
57. To the best of your knowledge, are you employed by, or a member of, any entity (business or non-profit) with proposals, programs, requests, businesses, applications, licenses or any other matters which may come before a board or commission for review, funding, support, or approval during the next two years?

    1. Yes
    2. No
59. If yes, please list the name of entity and interest:
61. Education and Experience
63. List most advanced degree received:
65. School:
66. Year:
68. Volunteer Experience/Community Service:
70. Please specify membership on any other governmental body in another jurisdiction:
72. Have you been a member of a City of Kerrville commission, board or committee?

    1. Yes
    2. No
74. If yes, please specify Board/Commission & Dates of Service
76. Please specify membership on any other governmental body in another jurisdiction:
78. To the best of your knowledge, are you employed by, or a member of, any entity (business or non-profit) with proposals, programs, requests, businesses, applications, licenses or any other matters which may come before this board for review, funding, support, or approval during the next two years?

    1. Yes
    2. No
80. If yes, list entity and interest:
82. What experiences qualify you to serve on the Senior Services Advisory Committee?
84. In your opinion, what are the three most pressing issues facing the Senior Services Advisory Committee?
86. What do you hope to accomplish by serving?
88. Please provide any additional information you believe would be useful in considering your application.
90. Certification*

    I am not employed by the City of Kerrville. If appointed, I will notify the City of Kerrville of any changes in my residence or business, or of any other relevant changes that would affect my appointment. I will also notify the City if any potential conflicts of interest arise. I recognize that my appointment requires my regular attendance and participation at all scheduled meetings. Failure to do so may result in my removal. I am willing to make this commitment of time and effort. I understand and acknowledge that by selecting the 'I Agree' option below, I hereby certify that all information in this application is complete, truthful and accurate to the best of my knowledge.

    1. I agree
    2. I do not agree
92. First Name
93. Last Name
95. Date
    Date
97. Note:
    When filed at city hall, this will become a public document that may be disclosed per the Texas Public Information Act.
Leave This Blank:


99. 1. Receive an email copy of this form.
100. Email address

     This field is not part of the form submission.

101. Submit Submit and Print

* indicates a required field