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GOEBEL SENIOR CENTER COMMISSION 1385 E. Janss Road, Thousand Oaks, 91362 • (805) 381-2744 • F (805) 495-5430 Conejo Recreation &Park District COMMISSIONER APPLICATION The Goebel Senior Center Commission is a nonprofit community service organization. Commissioner requirements include: • Applicants must be at least 50 years of age • Applicants must reside within the boundaries of the Conejo Recreation & Park District* • Applicants must be able to commit to a minimum of 15 volunteer hours each month • Applicants must be able to commit to assisting at a minimum of three Special Events annually * CRPD Boundaries include Thousand Oaks, Newbury Park, and the Ventura County section of Westlake Village Full Name: Today's Date: Address: Yes, I live within the boundaries of the Conejo Recreation & Park District (as outlined above). C-eeWPhone: Work Phone: E -Mail Address: Describe your work and/or volunteer experience relevant to the work of the Goebel Senior Center Commission. -i. qm em��j�►y.�d �y Se��oc ©Y,c �� c a Sen�o�- al�v a� myon' �� s a,� 1,Q, rkb� �e�}ems _ ►, hctive, Sewed -11 1b.Q\a�ic_V\A OCLk'j Qr� ttc\ �eeVy i n.) fi is iP' n1 ea.rA hr_ th -1 _ ► r.V o ecrv\k.C,6"r . w►tom rv�c\� S.e.n tn�s T .. - ' s 0,rk& m 11-.rtat, Med ea-�OuLSe.��ar 9Gc4�e? .. is N6 Ylee�1 4�nc1 u c+nirs i5 e_*AHv)S�ve:. i- Ca%_ A - ®-o L'L-V i` �\R A0, e� 1- c- eNe ' \, .._— �i ClZ } ��1� �vt,\d. u'�e cc ctv: 1 , k\..-` . %�se� cQc..5: _ WhLv are you in erestd in becoming a member of the Goebel Senior Center Commission? ((�� �+ r-na � � � U-1\VF't` �0 be, 0j "5 p •e r l �� e� � e i5 the.. -;-s me • j h e. Qek i o i 4- i e 5°�v vcL�'i ed Okf\6 +l)eV-2 (:,beeWG ' b.e. _y ov, �cv\)r�'tive-1-�1ci�r �ya�E o .�rVtr00Q%-X�e��, Vto "L( �c.c_crer+ b9i ila��cld CJe�e1�p� Cti�c\ i��O;�Ie- �rac•� Qv Q r� I C{NL9 �o�:1E SAN\O1'buQC;i�� 4 y �v �.cc��. tv.\� Fov V\�e Lie\1a-ur�_✓,e++�.� S i AvL 0.1noc�� Evevt for i NN�etlsi Vv\ Lk ,o a -A How would your appointment be beneficial to the Goebel Senior Center Commission? GJ4 kAe— � e 14ec, 7 UOOTr� U„etl U-1 `j LO -+'J ewe. look �-aht-:'Drk �O %-r\ kA WoOL) -�a6") any. - v -e p\e i to }\Ik�- e. a+mvv\tcv\'"r f M\c5 0 c r^ C>>^ v\i �!_Q l0 V6 i hbU5C:n 00, tic : iid y� Heb � W�ev? i\`evtvtUA'i CN\6 Ck�e., �E'iivi' e t` I hereby certify that the above information is accurate to the best of my knowledge and 11 also hereby acknowledge that intentionally providing false or misleading information on this application will disqualify me from becoming a commissioner. "`sll� _' _� 9 Notice to Applicant: You may include additional pages for Applicant Signature a Date Signed your responses or other attachments. Applications may be sent to mbraff@crpd.orq or delivered to the Goebel Adult Community Center at 1385 E. Janss Road, Thousand Oaks, CA 91362, GSCC Commissioner Application Page 1 of 1 Revised 01.2019