| Name: | |
| Address | | City | | | |
| | | Zip | | | |
| Primary Phone | | Other Phone | | | |
| Email | | | |
| Occupation: | | | |
| I will commit to attending 6-8 meetings per year on the 2nd Tuesday of the month at 6:30 pm | | |
| I am a Farmington Area School District resident. | | |
| 1. | If you are a parent/guardian please check all ages that apply | | | |
| 2. | What involvement have you had with Community Education in the past (programs enrolled in or services received? | | | |
| 3. | What personal skills would you be willing to share with our council and community? (Example: leadership, art work, time, organize classes, key communicator, advocate, volunteer at events) | | | |
| 4. | Indicate any special intereste areas you have within Community Education | | | |
| 5. | Please list any community groups you are involved with | |
| 6. | Please add any additional information or comments you wish to provide. | |