Birth to 25 Advisory Board Commission Application

Birth to 25 Advisory Board Commission Application

Additional Languages

Spanish | Russian | Vietnamese | Khmer | More Options

Optional - Print Application

Download and Print the Application: https://www.piercecountywa.gov/3035/Application or continue filling out the online application below.

Which of the following locations is most relevant to this appointment?

Select

Address

Residential Street Address NOT a PO Box

What is the ownership status of your place of residence?

Select

Are you a representative from any of the following organizations/communities?

Please select all that apply

A county-wide youth-serving organization

Tribal Community member

Early childhood education

Youth workforce development

The Behavioral Health community

A youth housing/homelessness organization

Pediatric medical community

The special needs community

Community Member referred by Council District

Please specific which organization/community group:

Pierce County Council District

Select

State Legislative Voting District Number

Not sure which district you live in? Use the Info By Address https://matterhornwab.co.pierce.wa.us/infobyaddress/

Occupation and Employer

(If retired, please indicate “Retired” with your former employer and occupation)

What is the highest degree or level of school you have completed?

Select

Education

(Name of high school, college/university, degree)

Professional/Community Activities

Describe your interest in serving.

Describe your qualifications for this position

File Attachments

Drag and drop files here or

Are you at least 18 years old?*

Select

Can you perform the essential functions and meet the attendance requirements for serving on this board/commission with or without an accommodation?*

Select

Are you, your spouse, or a member of your immediate family an employee of Pierce County? Yes / No If yes please identify:*

Select

Employee of Pierce County

If you answered yes to the question above please identify in the space below:

Are you currently serving on any other Pierce County Boards or Commissions? Yes / No*

Select

Serving on any other County Board or Commission

If you answered yes to the question above, please identify in the space below:

Personal Reference #1 Name

Personal Reference #1 Occupation

Personal Reference #1 Address

Personal Reference #1 Phone

Personal Reference #2 Name

Personal Reference #2 Occupation

Personal Reference #2 Address

Personal Reference #2 Phone

Personal Reference #3 Name

Personal Reference #3 Occupation

Personal Reference #3 Address

Personal Reference #3 Phone

Send me a copy of my responses