City Forms - Disabilities Commission Application

The Oaks Initiative, also known as the "Taxpayer Protection Act," was adopted by Santa Monica voters on November 2000, and amends the City Charter. Its requirements affect all City-elected and appointed officials, including Council-appointed board and commission members. Related litigation on this matter recently concluded, and accordingly, the City is implementing the Initiative. The City Attorney prepared the following information about the Initiative that may affect you if you are appointed to a Santa Monica Board or Commission. Please read it carefully before completing your application. Select the format you would like to view: html | PDF | MS-Word

Members must be residents of the City who have significant experience in the disability community. At least six of the eleven members shall be persons with disabilities.

* indicates required information

INFORMATION TO BE DISPLAYED ON INTERNET:

Prefix*:
First Name*: Middle Name:
Last Name*:
Public Address:

City: State: Zip:
Phone: format (xxx) xxx-xxxx Fax: format (xxx) xxx-xxxx
E-mail:

Reside in Santa Monica*?	Yes	No	No. of years

Are you applying for one of the seats reserved for those with a disability*?	Yes	No

Specify current or prior service on City Boards/Commissions:

List Community activities in which you are involved:

Describe your qualifications, experience, and education, and list any technical or professional requirements you have relative to the duties of the Disabilities Commission.

What are your goals in serving on the Disabilities Commission?

BUSINESS INFORMATION: OKAY TO DISPLAY ON INTERNET*? Yes No

Occupation*:
Bus. name:
Bus. address:

City: State: Zip:
Phone: format (xxx) xxx-xxxx Fax: format (xxx) xxx-xxxx

FOR CONFIDENTIAL USE ONLY:

Residence Address*:

City*: State*: Zip*:
Phone*: format (xxx) xxx-xxxx Cellular: format (xxx) xxx-xxxx
ALL INFORMATION, EXCEPT INFORMATION ENTERED IN THE CONFIDENTIAL SECTION, IS PUBLIC AND AVAILABLE FOR VIEWING AT THE CITY CLERK'S OFFICE AND ON THE CITY'S WEB PAGE (EXCEPT AS NOTED ABOVE).

DISABILITY RELATED ASSISTANCE AND ALTERNATE FORMATS OF THIS DOCUMENT ARE AVAILABLE UPON REQUEST BY CALLING (310) 458-8211