Poverty and Homelessness Board Application

The Lane County Board of Commissioners in cooperation with the Cities of Eugene and Springfield through the Human Services Division (HSD) is seeking applications to fill eleven (11) positions on the Poverty and Homelessness Board (PHB).

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* 1. Which representative position do you seek to fill?

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* 2. Please specify how your experience relates to the representative position for which you are applying (i.e. why did you select the above choice)

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* 3. Your name

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* 4. Email Address

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* 5. Phone number

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* 6. Current address or mailing address

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* 7. Occupation or Affiliation

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* 8. Optional: What gender do you identify as?

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* 9. Give a brief description of the experience that qualifies you for membership on this Poverty and Homelessness Board advisory group. (If you wish, you may email additional pertinent material to Alexandria.Dreher@lanecountyor.gov)

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* 10. Why do you want to become a member of this advisory group , and what specific contributions do you hope to make?

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* 11. List the community concerns related to this advisory group that you would like to see addressed if you are appointed.

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* 12. Lane County is committed to reflecting diverse cultures on its boards/committees and does not discriminate against any person on the basis of gender, race, color, national origin, religion, disability, or age in employment or in admission, treatment, or participation in its programs, services, and activities. If selected, how would you contribute to this effort?

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* 13. Are you currently serving on any Advisory Boards, Tenant Councils, Committees, or Community Groups? If so, which ones?

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* 14. Are you employed by, have any business, contractual arrangements or family connections with programs having contractual agreements with the County or that might be within the purview of the advisory group on which you are seeking appointment? (If there is a change in your circumstances, please advise the staff for the committee within 30 days.)

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* 15. If you answered yes, please specify. 

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* 16. How did you learn about this vacancy?

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* 17. In which County Commissioner District do you reside? Please select one. 

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