"Telling Bothell's Full Story" Advisory Committee 

2. First Name
3. Last Name
5. Address
7. City
8. State
9. Zip Code
11. Phone Number
12. Email Address
14. Occupation
15. Gender Identity
17. How do you describe your race and ethnicity?
19. Committee members must be Bothell residents, relatives of past Bothell families, business owners, employees, students or a professional with history, historic preservation archaeology, diversity, or cultural competency skills or certifications. How do you fulfill this requirement?
21. Please list any relevant skills and qualifications you have acquired from employment, previous volunteer work, or through other activities
23. Do you have any ancestors who lived, worked, or attended school in the Bothell area? If yes, please provide a brief explanation of their activities including approximate dates.
25. Please describe any experience you have with regard to historic preservation, historical and archival research, and oral interviews (experience not required).
27. What specific insights will you bring to the committee with regard to the history of the BIPOC community in the Bothell area?
29. Do you currently serve on another City of Bothell Board or Commission?

    1. Yes
    2. No
30. If yes, which one?
    -- Select One --Arts CommissionCivil Service CommissionCouncil Salary CommissionLandmark Preservation BoardLEOFF Disability BoardLibrary BoardLodging Tax Advisory CommitteeParks and Recreation BoardPlanning Commission Shorelines BoardOther
32. Why do you wish to serve on this advisory committee?
34. What do you see as the function of this committee?
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field