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2. First Name*
3. Last Name*
5. Address1*
7. Address2
9. City*
10. State
11. Zip*
13. Is this address located within the Town's ETJ or Planning Jurisdiction?
    -- Select One --ETJPlanning JurisdictionI don't know
14. Is this address located within the corporate limits of the Town of Carrboro?*
    -- Select One --YesNo
16. Email Address*
17. Telephone*
19. The demographic information provided below is of interest because your elected officials want the Town's advisory boards to reflect the diversity of the Town. Diversity of the applicant pool is a priority of the Town Council.
21. Date of Birth*
    Date of Birth
22. Race*
23. Sex*
25. How long have you lived in Orange County?*
26. How long have you lived in Carrboro?*
28. Why do you want to be on the Safe Routes to School Committee?*
30. Which spot are you applying for?*
    -- Select One --(2) Student attending elementary or middle school in Carrboro(1) Parent of a child attending school in Carrboro(1) Faculty/Staff working at a school in Carrboro
31. Which school do you attend or work at?
    -- Select One --Carrboro ElementaryChapel Hill HighSmith MiddleSeawell Elementary McDougle ElementaryMcDougle MiddleMorris Grove Elementary
33. Have you ever served on any Town of Carrboro Board or Committee?*
    -- Select One --YesNo
34. If yes, which board/committee(s)?*
36. Are you currently serving on a Town Board or Committee?*
    -- Select One --YesNo
38. A term on the Safe Routes to School Committee is two years in length. After completing two full terms, a member must take off one year before applying for re-appointment to the committee. A committee member may opt to apply to serve on another advisory board if desired. The Council may make exceptions to this rule under the following circumstances: 1. To retain diversity on the committee; 2. A lack of applicants.
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40. 1. Receive an email copy of this form.
41. Email address

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