b l a n c a ~ a l v a r a d o ----<--@ boards and commissions

*Full Name:*
Last (required)	First (required)	Middle

Address:		Home Phone: (required)
		Business Phone:

How long have you been a resident of Santa Clara County?
	Months Years
In which supervisorial district do you live?
	District 1 District 2 District 3 District 4 District 5
*Occupation:*

*Education:*
	High School Degree College Degree Masters Degree Doctoric Degree Other
On which Advisory Boards,Commissions or Committees would you like to serve? (Please list in order of preference)

*Why do you want to become a member of a County Advisory Board or Commisions?*

*Please list your qualifications thought applicable for appointment.*

*Are there any special interests or activites that you wish to bring to attention of the Board of Supervisors?*

*Do you have any obligations that might affect your attendance at scheduled evening meetings?*
	No Yes. If Yes, please explain below:
*This space is provided for any additional information you may have about yourself or the position being sought.*

*Please list three references:*
1.	Name:
	Address:
	Phone:

2.	Name:
	Address:
	Phone:

3.	Name:
	Address:
	Phone: