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02.a Decker - Planning Commission ApplicationCommittee or Commission Application Name *Address * Phone *Email * Residency * Committee or Committee * Have you served on any Scandia Committee or Commission in the past?* Experience Special Interests Volunteer History Optional In accordance with M.S. 13.04 Subd. 2 we must inform you of your rights as a subject of government data. The information you give us about yourself is needed to identify you and assist in determining your suitability for the positions(s) for which you are applying. The information that we collect about you is classified as either Public or Private. Public means that it is available to anyone who asks to see it. Private means that the information is available only to the person the information is about and to the staff who must use it in the normal course of conducting City business and as otherwise provided for by law. By entering my full name, I am affixing my signature to this application and acknowledging that an investigation may be conducted for use in determining my qualifications. I hereby expressly authorize release of any and all information which any organization, company or person may have, including information of a confidential or privileged nature. I hereby release the City and any organization, company or person furnishing information to the City, as expressly authorized above, from any liability for damage which may result from furnishing the information requested. Theresa Decker 18650 Norell Ave ( 6 months How long have you been a resident of Scandia? Select the Committee you are applying to: Capital Investment Committee Parks and Recreation Committee Planning Commission Tourism Committee Wastewater Committee Yes No List any governmental, service organizations, or professional activities which you have been or currently are involved in: I have been a mortgage professional for 14 years and have also worked in construction and design for the past 6 years. I served on the Minnesota Mortgage Association board for 2 years as well. List any of your special interests, activities or hobbies which you have that would apply to this committee: I am interested in design, construction, entrepreneurship, equal housing access initiatives, travel, community service, music. I love spreadsheets, numbers and making sense of complex details. In what volunteer activities have you participated? What was your role? I volunteer as a worship leader at my church (14 years), youth worship coach (5 years), I serve on the board of trustees for Substance Church (2 years+) and previously served as a board member for the Minnesota Mortgage Association (2 year term). You may attach a resume. The selection process will vary according to the number of applicants and vacancies. Your application will be kept on file for one year. Signature *Theresa Decker Typing your name in the box will be considered an electronic signature