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Department of Transportation
Department of Transportation

Application form

First name
Last name
Street address
City
State
Home phone
Work phone
If employed,
employer’s name
Occupation
  1. Do you use ACCESS paratransit service? Yes   No
  2. What bus routes do you ride?
  3. Describe issues you believe this committee should address.
  4. List organizations you belong to or have belonged to and any leadership positions you have held in those organizations.
  5. Describe why you want to be a member of the King County Accessible Services Advisory Committee.
  6. Please list the experience and accomplishments, either paid or volunteer, that you would bring to this committee.
  7. Optional: List three references, including names, addresses, and telephone numbers.

Additional voluntary information

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

Age
Sex Female  Male
Ethnic origin
Disability (if any)

Last update: September 12, 2008

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