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2. 
4. Name*
6. Address1
8. Address2
10. City
11. State
12. Zip
14. Email
15. Phone Number
17. Are you a resident of the city of Pueblo? *

    1. Yes
    2. No
19. Please select the district for which you are applying to represent: (check one)

    1. District 2
    2. District 4
21. How long have you been a resident of the city of Pueblo? *

    1. Less than a year
    2. 1-2 years
    3. 3-5 years
    4. 5-10 years
    5. 10+ years
23. How long have you lived in your neighborhood? *

    1. Less than a year
    2. 1-2 years
    3. 3-5 years
    4. 5-10 years
    5. 10+ years
25. Are you or a family member employed by the City of Pueblo? *

    1. Yes
    2. No
27. Age

    1. 16-24
    2. 25-34
    3. 35-44
    4. 45-54
    5. 55+
29. Are you planning to submit a project for your neighborhood or a community organization? *

    1. Yes
    2. No
31. Please explain how you would assess a project proposal from an equitable lens.*
33. Please provide a brief narrative of why you'd like to participate in the review committee (400 words or less).*
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35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

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