citizen application for membership transportation planning ... · please complete the attached...
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CitizenApplicationforMembershipTransportationPlanningOrganization(TPO)
CitizensAdvisoryCommittee(CAC)
Name:___________________________________________________________________________Organization(ifapplicable):___________________________________________________________Address:__________________________________________________________________________City/State/Zip:_____________________________________________________________________Phone(Home/Cell/Business):_________________________________________________________E-Mail:___________________________________________________________________________Race/Ethnicity(optional):____________________________________________________________Checktheboxthatapplies:
q Iamapplyingfornewmembership.q Iamareturningcommitteemember.Myinformationisstillcurrent.(bycheckingthisboxthereisnoneedtocompleteanewapplication.)
Myreasonsforwantingtobeinvolvedinthiscommitteeare:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Potentialconflictsofinterest:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________(Theseaffiliationsdonotnecessarilyprohibityoufrombeingonacommittee.Thisinformationisonlyrequestedtoinsurethatpotentialcommitteemembersdonothaveaconflictofinterest.)
Informationprovidedinthisdocumentbecomesapublicrecord.
StafftoTPO
Pleasereadandconfirmyourunderstandingofthefollowing:
• Avotingmembershipmaybeattainedinoneofthefollowingways:• Acitizenof theTPOstudyareamaybenominated formembershipbyaTPOmember,
localgovernment,theCAC,orotherorganizationsandbeapprovedbytheTPO;or• A citizen of the TPO study area may directly petition the CAC for nomination for
membershipandbeapprovedbytheTPO.• CACmembers shall notbeelectedofficialsoremployeesofpublicorprivateagenciesdirectly
involvedintransportationorland-useplanning.• AnymemberwhoexpectstobeabsentfromameetingshallinformtheTPOstaffassoonas
practicabletoreceiveanexcusedabsence.Ifamemberisconsistentlyabsentwithoutanexcusedabsence,theCACmayrecommendtotheTPOthatthememberberemovedfromtheCAC.Threeconsecutiveunexcusedabsencesbyamembershallbegroundsforsuchrecommendation.
• CACcitizenmembersareexpectedtoattendmeetingsintheplanningareabytheirownmeans.ThemeetingfacilitiesmeetallADArequirements
• CACmembersmustbelegalU.S.citizensandresidentsoftheTPOstudyarea.• CACcitizenmembersareapprovedbytheTPOandmembersserveatthepleasureoftheTPO.• TheTPOconductsanannualreviewofadvisorycommitteemembership.• ToserveontheCAC,theapplicantmusthaveattendedacommitteemeeting,berecommended
forapprovalbythecommittee,andattendtheTPOmeetingwheretheywillbepresentedformembership(whenschedulingpermits)andbeapprovedbytheTPO.BoththecommitteemembersandTPOmembersmayaskquestionsoftheproposednewcommitteeapplicant.TheadvisorycommitteemembersmayberemovedatanytimebytheTPO.
Ihavebeengiventheopportunitytoreviewtheaboveinformation,readtheby-laws,andIunderstandandwillcomplywithallstipulations.FL-ALCACBy-Lawsmaybefoundatwww.wfrpc.org._________________________ _________________________________________________PrintedName Signature DateIunderstandthatrefusaltosignwillresultintheterminationoftheapplicationtoserveoneithercommittee.Forquestionsconcerningthisapplication,pleasecontactBrittanyEllersat(850)332-7976x220.PersonsneedingaspecialaccommodationtoparticipateinanadvisorycommitteemeetingshouldcontactBrittanyEllersat850-332-7976x220ore-mailatbrittany.ellers@wfrpc.org.
Pleasecompletetheattachedbackgroundformorattacharecentresume.(Acompletedbackgroundformorresumemustaccompanythisapplication.)
BackgroundForm(Tobeusedifaresumeisnotavailable)
Name:___________________________________________________________________________Address:__________________________________________________________________________City/State/Zip:_____________________________________________________________________Phone(Home/Cell/Business):_________________________________________________________E-Mail:___________________________________________________________________________CommunityInvolvement:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________WorkExperience:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Education:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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