Instructions: Thank you for taking the time to fill out this application. Don’t hesitate to keep it brief, but please provide us the information that we need to understand who you are and why you would like to join the Pittsfield Listens Family And Community Engagement Group.

Please Note: Read the FACE Working Group Information Sheet prior to filling out this application. Application deadline is Friday January 27 at 5 pm. 

Please ensure that this application is filled out online (survey below), or visit Pittsfield Listens on Facebook for a copy to download and email (mobaxley@pittsfieldlistens.org), drop-off (74 Main St. at Pittsfield Community Center), or mail (P.O. Box 206 Pittsfield, NH 03263). For questions, contact Pittsfield Listens at info@pittsfieldlistens.org.

We will notify applicants in March about the FACE Working Group membership and convene an initial meeting soon thereafter. We look forward to reviewing all applications and are thrilled to continue this work with you for Family and Community Engagement with the Pittsfield School District!

* 1. What is your first name?

* 2. What is your last name?

* 3. In what town do you live in?

* 4. What is your gender?

* 5. What is your age?

* 6. List some of your community interests and/or involvement

* 7. What is/are your connections to Pittsfield Schools (i.e. parent, PMHS alumni, family member of a student, volunteer)?

* 8. Why are you interested in joining the FACE Working Group?

* 9. What important skills and perspectives would you bring to the FACE Working Group?

* 10. At what email address would you like to be contacted?

* 11. What is the best phone number to reach you on? Please specify if call or text is preferred.

* 12. Is there anything else you you’d like to share about your schedule and availability?

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