Measure W Application Form: Working Group & Oversight Committee

Measure W Application Form: Working Group & Oversight Committee
Applicant Information
Applicant Name*

First NameLast Name
Applicant Email Address*
example@example.com
Applicant Phone Number*
Please enter a valid phone number.
Are you applying to be a Working Group Member, or an Oversight Committee Member?*

Working Group MemberOversight Committee Member
Check to apply to be a Working Group Member and/or an Oversight Committee Member.*

Working Group MemberOversight Committee Member
Oversight Committee
Working Group Members can live and/or work in the West Marin Tax Area. Oversight Committee Members must live there.
Do you live in the West Marin Tax Area?*

YesNo
Oversight Committee applicants must live in the West Marin Tax Area.
Primary Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant City and ZIP Code: {primaryResidential:city} {primaryResidential:postal}
Are you over 18 years of age?*

YesNo
We are unable to proceed with your application. Applicants must be over 18 years of age.
Are you employed?*

YesNo
Is your place of employment located in the West Marin Tax Area?

YesNo
Working Group Members must either live and/or work in West Marin.
Current Occupation*
Employer's Name*
Employer's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer City and ZIP Code: {employersAddress:city} {employersAddress:postal}
Has any organization of which you are an officer or employee received funds from the County, or provided services to the County?*

YesNo
List organization(s) and nature of relationship to the County:*
When would you be able to participate in meetings? Please indicate all possibilities.*

MorningsAfternoonsEvenings
Will you be able to join meetings online using Zoom or another online platform?*

YesNo
Narrative Information for Working Group
West Marin’s housing market has an unusual set of constraints, including regulation by the Coastal Commission, impacts from being a popular vacation destination, and the community’s remote and rural nature. What challenges do you see in West Marin County related to providing community housing? *

1000 Word Limit0/1000
Why do you want to be a member of the Working Group? What perspectives and experiences will you bring? What do you expect to contribute by being part of the Working Group? *

1000 Word Limit0/1000
Have you ever served or participated in a community, nonprofit, or County group or organization that works on housing-related issues? If so, what group or organization? Please describe. *

1000 Word Limit0/1000
Please indicate at least one of the following topics where you feel you could contribute:*

Knowledge of the housing market as a renter in West MarinFamiliarity with affordable housing, development, management, or financingFamiliarity with housing as an employer in West MarinFarm worker, or agricultural producer who provides housingReal estate, especially financingLandlord in West MarinKnowledge of local planning, building, or affordable housing policyNeighborhood/community involvement
Please briefly describe your community involvement:*
Narrative Information for Oversight Committee
Why do you want to be a member of the Oversight Committee? What perspectives and experiences will you bring? What do you expect to contribute by being part of the Oversight Committee? *

1000 Word Limit0/1000
Please indicate at least one of the following topics where you feel you could contribute:*

Financial management and reportingPublic agency administrationProvision of fire-related servicesProvision of emergency-related servicesProvision of community housing-related servicesOther
Please briefly describe:

200 Word Limit0/200
Have you ever served or participated in a community, nonprofit, or County group or organization that works on issues related to housing, fire, or emergency services? If so, what group or organization? Please describe. *

1000 Word Limit0/1000
Please describe how you would help support excellence in public service and help the County effectively respond to the needs of the diverse residents we serve.*

1000 Word Limit0/1000
Please describe your experience in engaging with members of all races, people from a wide variety of ethnic and socioeconomic backgrounds, and people with disabilities. *

1000 Word Limit0/1000
Additional qualifications or comments

1000 Word Limit0/1000
Demographic Information
Information on demographics is optional and will only be used to support a diverse working group. To ensure that our committee meetings are inclusive and accessible to everyone, please let us know if there are any accommodations or adjustments we can make to support your participation in the additional comments box above.

Please provide information on your race and ethnicity below.

	Hispanic	Non-Hispanic
Asian
Black/African American
Native American
Native Hawaiian/Pacific Islander
White
Other/Multi-Racial

Please provide information on your disability and familial status below.

	Yes	No
Person with disabilities
Family with children under 18
Female head of household

Documents
Please feel free to attach any additional documents or information pertaining to your candidacy.
File Upload

Allowable file types: pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif
Cancelof
Learn about Stipends for members of boards and commissions. If you are selected to join one of the Measure W committees, we will reach out to you with a stipend application.
Check this box if you are interested in receiving additional information about the County's stipend program*

I am interested in receiving additional information about the County's stipend program.
By checking this box*

I certify that all information included in and attached to this application form is true and correct.
Application Status - Working Group*
Application Status - Oversight*
Should be Empty:

Measure W Application Form: Working Group & Oversight Committee

Applicant Information

Narrative Information for Working Group

Narrative Information for Oversight Committee

Demographic Information

Documents