Racial & Cultural Diversity Commission Application

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Information provided on this form will be a public record subject to free and open examination by any person under the Arkansas Freedom of Information Act.

(Please select one of the options below.)

Is this a:

New Application
Request for Re-appointment

Applicant Information

** Name:	**Telephone Number:
** Physical Address:	Alternate Number: **Email Address:
**State:	**Length of Residency in Little Rock:
**ZIP Code:

Please submit a letter addressed to the Mayor and the Little Rock Board of Directors expressing your desire to be reappointed:

Are you registered to vote in the City of Little Rock? YesNo

Qualifications:

Highlight the skills you posses that will enhance the effectiveness of the Commission:

Outline your experience with other Boards and/or Commissions:

Describe your first interest in the issue of racism, civil rights, diversity, etc.:

Explain your philosophy regarding the value of diversity:

Describe your experience(s) with individuals of diverse backgrounds:

Explain your plan for dismantling racism in the City of Little Rock:

What knowledge or experience do you hope to take with you upon completion of your Commission appointment?:

What impact do you hope your Commission term will have on the City of Little Rock?:

Resume:

Self-Identification Survey

The City of Little Rock and the Racial and Cultural Diversity Commission seeks to increase diversity in applicants for City Boards and Commissions. Your demographic information will be used to track and enhance diversity in our Boards or Commissions.

Race/Ethnic Group: (select one or more)

White
Black or African American
Hispanic or Latino (of any race)
Asian
American Indian or Alaskan Native
Native Hawaiian or Other Pacific
Other:

Gender: MaleFemale

Age: 18-25 26-35 36-45 46-55 56 & over

How did you learn of this Board/Commission vacancy?

City Website	Community Agency, specify
Referred by Board/Commission Member	Newspaper, specify
Referred by City Director or Staff	Other, specify
Local Government Access Channel

The City Code of Ethics prohibits any the member of any City Board, Commission or Authority, from voting on a matter in which the member has an interest, or the member’s family or business has an interest. If such a matter comes before the body to which you are appointed, and there is any question about recusal, you should contact the City Attorney’s Office for an informal or formal opinion as to the propriety of your participation.

Please upload a current resume with your application. Or submit forms to: Little Rock City Clerk’s Office, 500 West Markham Street, Room #200, Little Rock, AR, 72201, by e-mail to cityclerksoffice@littlerock.org, or by fax to (501) 371-4857.

Board and Commission meetings may require day or evening attendance. For more information regarding Boards/Commissions, including meeting times and duties please visit Boards and Commissions Page