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Winooski Commission for Inclusion & Belonging Application

  1. Additional Commission Service

    Participation on the Inclusion and Belonging Commission requires placement as an ambassador on an additional city commission. Please identify your interest in serving on the following city commissions in order of preference - 1 being first choice, 5 being last choice.

  2. (planning, zoning, ordinences) 

  3. (parks, pool, senior center, library, programs, etc.) 

  4. (home ownership, renting, affordability, etc.) 

  5. (streets, sidewalks, water systems, etc.) 

  6. (city budgets, spending, grants, etc)

  7. Interpretation Requests

    Please note, language interpretation services will be provided on an as-needed basis for any commissioner who makes a request. 

  8. Will you need interpretation services?
  9. Waiver*

    I recognize that as human beings, we all intersect in multiple identities drawn from race, gender identity, sexual orientation, religion, ability & ethnicity. I know that differences in race, culture & ethnicity are essential and valued parts of an inclusive society, and recognize that these different perspectives are an asset to the City of Winooski. I understand and agree that submitting this application form does not qualify as automatic registration and that certain qualifications must be met (including the acceptance of established policies and procedures provided by the organization of interest). By clicking yes and submitting this form, I attest that the information I have provided on the form is true and accurate. 

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  11. This field is not part of the form submission.