Citizen's Advisory Committee Application

Check box for each project *

Living Breakwaters (Staten Island)

Living with the Bay (Nassau County)

Guidelines *

I understand that this is an advisory committee.

I will attend each quarterly meeting (or as otherwise scheduled), during the term of the CAC (as determined by GOSR).

I will commit my time to this CAC as necessary (estimated 1-2 hours a week, slightly more for Co-chairs).

If selected, I understand that I will need to provide additional information required by GOSR to conduct a background check.

First Name *

Last Name *

Street address *

City *

State *

Zip Code *

Date of Birth *

Month

Day

Year

Email *

Telephone Number *

Race/Ethnicity (Optional)

An important component of the RBD process and what will make the CAC a success is including a diverse range of individuals that comprise and reflect the community where the project is located. Please consider disclosing your race/ethnicity (optional).

Primary Language Spoken (Optional)

An important component of the RBD process and what will make the CAC a success is including a diverse range of individuals that comprise and reflect the community where the project is located. Please consider disclosing your primary language spoken (optional).

Gender (Optional)

Describe which component of the RBD project or process in which you are most interested in *

Are you affiliated with any of the following types of organizations? *

An important component of the RBD process is the participation of a diversity of individuals that comprise and reflect the community where the project is located. Members of the CAC are expected to represent a broad range of stakeholders both locally and regionally from varied organizations and interests. To meet this goal, GOSR is seeking applicants who are affiliated with relevant organizations, some of which are listed below. Please note that being affiliated with an organization is not mandatory to be a CAC member.

If affiliated with any of the above types of organizations, please specify the name of the organization, your position, and the years you served *

Please expand on one or two of your affiliations above that is the most significant to you, or will serve you best, in your position with the CAC *

Why are you interested in joining the CAC, and how will the CAC benefit from your involvement? *

Co-Chairs (Optional)

This CAC will be led by two co-chairs. While co-chairs will be equal to all other members of the Committee, it is expected that co-chairs will lead CAC meetings, advise GOSR on agenda items, help schedule meetings, and serve as a primary point of contact for the CAC. Co-chairs will be selected by GOSR. Please note that the co-chair position will require a more substantial time commitment. If you are interested in serving as a co-chair, please provide a brief explanation as to why you would make an exceptional co-chair.

Resume (Optional, but strongly preferred) - Please enter resume text in the space provided and email as an attachment to [email protected]

If applicable, please provide any additional information below (optional)

Statement on Conflicts of Interest *

We kindly ask all applicants to disclose all conflicts of interests that may give the appearance of impropriety, should you be chosen to sit on the RBD Citizens' Advisory Committee (e.g. if you are a marine contractor that would stand to gain financially from sitting on this Committee). Please note that you are not necessarily prohibited from sitting on the CAC if you have a conflict of interest. We will evaluate each application on a case-by-case basis to make a final determination. Should you be selected as a memeber CAC, we may request additional information regarding your conflict(s) of interest. If you have any further questions regarding conflicts of interest, please email GOSR's Ethics Officer at [email protected]

Signature Box *

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