First Name (required)
Last Name (required)
Home Address (required)
Home Phone Number (required)
Work Address (required)
Work Phone Number (required)
Job Title / Employment (required)
How long have you lived in Roscoe Village?
How have you been active in this community or in others in which you have lived?
What experience and skills, professionally or from other volunteer activities, would you bring to the Board of Roscoe Village Neighbors? Please provide specific examples. Please also include educational degrees/background.
What community issues most interest you? What contributions do you plan to make as a board member to affect these issues?
Please provide two references, including their address, telephone number, and their relationship to you.
Please upload a recent headshot of yourself.