Bridge to Success Community Partnership 2017 Community Council information form

The BTS Community Council is intended to be a reflection of Waterbury and strives to do its work in an open and transparent manner with public participation and collaboration. People of all ethnicities, people with disabilities, veterans, and LGBT candidates are strongly encouraged to apply.

* 1. Name

* 2. Representing (organization, parents, etc.)

* 3. Title/Position/Role (please provide a brief description of your work or your role in the community)

* 4. Brief description of your work or role if applicable:

* 5. Are you a Waterbury resident?

* 6. Telephone number

* 7. Email Address

* 8. Mailing Address

* 9. Open Opportunities - please check the Bridge to Success Community Partnership volunteer opportunities in which you are interested (Community Council meetings are the 2nd Tuesday of the month from 2:00-4:00 PM):

* 10. Please describe any relevant life, volunteer, or paid experience you believe qualifies you for the seat you are interested in filling:

* 11. Follow up discussions will be conducted with the BTS Governance committee to be scheduled at the convenience of the committee and interviewee. Notice of decisions of the Council will be made to interviewees as soon as possible and may begin their terms, if selected, at the next regularly scheduled Council meeting. Are you interested in, and available to participate and attend Community Council meetings (generally held the third Tuesday of each month from 2:00-4:00 PM)?

* 12. Please explain how you would make yourself available for meetings, and how you would contribute your thoughts and ideas to the BTS Plan Implementation process:

* 13. Would you like to become a member of any of the following workgroups?

* 14. Please provide any additional information you wish to add for review by the BTS Community Council: