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1. Briefly describe why you are interested in serving on the requested Standing <br />Committee of the South Bend Common Council: <br />2. Provide a brief summary of the issues and/or topics you believe should be addressed <br />by this Standing Committee/ Board this Calendar year. <br />3. Provide a brief summary of your participation in any professional, public service, <br />not- for - profit, or other organizations: <br />4. nvauamnry to anew �:ommrtteet Board meetings on weekdays beginning at <br />3:00 p.m. <br />ZALZ <br />I verify that the above information is true and correct to the best of my knowledge. If <br />selected to serve on a South Bend Common Council Startling Committee/ Board, I agree <br />to regularly attend such Committee/ Board meetings, to participate inthe review of <br />documents sent to the Committee/ Board, to participate during the Committee's' Board's <br />hearing nd to abide by all governing rules and regulations <br />sign atureolLcizen Meruber Candid ate Date <br />FnntW/ Pype3'Nmn`66keen Mmid etd e—'—" <br />Return completed application to: <br />Common Council, 227 W. Jefferson Blvd., Suite 400 S., South Bend, IN 46601 <br />E -mail: ccouncilQsouthbendinga_v <br />FAX 574.235 -9173 <br />