Online application form

First name

Last name

Street address

City

State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY   Zip

E-mail

Daytime phone

Evening phone

If you are employed:

Employer

Occupation

Please note: Members may not be King County employees. If you have a possible conflict of interest—contract work with King County, for example—please consult with the King County Board of Ethics, 206-296-1586, before applying.

1. Do you use Metro’s Access Transportation Service?    Yes    No

2. Do you have experience working with people who frequently use Metro’s Access Transportation service?
   Yes    No

3. What bus route(s) do you ride?
   
4. What other bus route(s), if any, are you very familiar with?
   
5. Describe issues you believe this committee should address.
   
6. List organizations you belong to or have belonged to and any leadership positions you have held in them.
   
7. Describe why you want to be a member of King County Metro Transit’s Accessible Services Advisory Committee.
   
8. Please list the experience and accomplishments, either paid or volunteer, that you would bring to this committee.
   
9. Optional: List three references, including names, addresses, and telephone numbers.
   

Because we want the committee to reflect the diversity of the community, we would appreciate the following information:

1. Age
   
2. Sex:    Female    Male
3. Race/ethnicity
   
4. Disability (if any)
   
5. Any other information about yourself that might contribute to outreach to diverse communities: