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Everett Essentials Application 2020

2. Participant selection
   Applicants will be selected based on personal interest in getting involved in local government, public service and leadership roles. Our goal is to create a class makeup that broadly represents Everett’s neighborhoods and community. The deadline to apply is Jan. 20, 2020.
4. First Name*
5. Last Name*
7. Address*
9. City*
10. Zip Code*
11. Phone Number*
13. *Email Address
14. Do you live in Everett?*
    -- Select One --YesNo
16. Which neighborhood do you live in?*
    -- Select One --BaysideBoulevard BluffsCascade ViewDeltaEvergreenGlacier ViewHarborview-Seahurst-GlenhavenHollyLowellNorthwestPinehurstPort GardnerRiversideSilver LakeSouth Forest ParkTwin CreeksValley ViewView Ridge-MadisonWestmont
17. Do you work in Everett?*
    -- Select One --YesNo
19. What is your occupation?*
20. Are you a student in Everett?*
    -- Select One --YesNo
22. How did you hear about this course?*
24. Minimum age requirement*

    1. I confirm that I am at least 16 years old
25. Parent/guardian permission required for participants 16-17 years old

    1. I will be 18 or older by Feb. 29, 2020
29. Questions
    We want to learn more about you. Please briefly respond to the following questions (300 words or less).
31. 1. Please describe your past and present involvement in your community.*
33. 2. Why do you want to be involved in local government?*
35. 3. What do you want to learn from taking this course?*
37. 4. How do you want to use your experience in this course to help the community?*
39. Course fee
    The cost for Everett Essentials is $50 and includes light refreshments and all materials. The Saturday events will include lunch.
41. If you cannot afford the course fee, we can help with the cost.

    1. Check this box if you need help paying for the course.
43. Attendance*

    1. If accepted, I pledge to attend a minimum of 8 of the 10 sessions. I understand that if I attend less than 8 sessions, I will not graduate.
47. Nondiscrimination and confidentiality statement
    Everett Essentials does not discriminate against applicants and participants on the basis of race, age, disability, religion, gender or sexual orientation. Applications are held strictly confidential.
49. Optional
    In order to help us select a class that represents the city of Everett, we encourage applicants to fill in the following information:
51. Age
    -- Select One --16-1718-2930-3940-4950-5960 or older
52. Gender
53. Please indicate your ethnic/cultural identification:
55. Deadline to apply is Jan. 20, 2020
    Questions about the application? Email community@everettwa.gov
Leave This Blank:


57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit Submit and Print

* indicates a required field