3. 
6. EL CENTRO DEL QUINTO SOL RECREATION CENTER
   BOARD OF DIRECTORS
   Application for Appointment
8. Contact Information
10. DATE
    DATE
12. FIRST NAME
13. Middle Initial
14. LAST NAME
16. HOME ADDRESS
18. CITY
19. STATE
20. ZIP
22. HOME PHONE
23. WORK PHONE
24. CELL PHONE
26. E-MAIL ADDRESS
28. ARE YOU CURRENTLY EMPLOYED WITH THE CITY OF PUEBLO?

    1. Yes
    2. No
29. OCCUPATION (or if RETIRED, your previous occupation)
31. Board Membership Structure
33. Please select the position that you are applying for:

    1. Resident of City Council District 2 (East of I-25)
    2. Business-owner operating East of I-25 in Council District 1 or 2
    3. Parent of a Child participating in programming at El Centro del Quinto Sol Recreation Center
    4. Student at East High School
    5. Youth – Age 10-14 Residing East of I-25 in City Council District 1 or 2
    6. At Large Resident of the City of Pueblo
35. Questionnaire
    Please complete the following general information.
37. Please elaborate on your qualifications or interest based on the category you selected above?
39. Why are you interested in being appointed to serve on the El Centro del Quinto sol Recreation Center Board of Directors?
41. Please list your areas of experience and/or accomplishments that you feel could assist the mission of this Board.
43. What goals would you like to see this Board accomplish?
45. List any other items that might be useful in consideration for your appointment to this Board.
47. List any other civil or Community Commissions or Boards that you currently serve on.
51. Upload resume, references and/or other pertinent information
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52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit Submit and Print

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