MCCED Online Application

Name *

Date of Birth *

Street Address *

City *

County *

Zip Code *

Phone *

Is it OK if we text you with information about MCCED?

Yes

No

Email *

What is the best way to reach you?

Phone

Email

Text

Postal mail

Are you a Multnomah County employee? *

Yes

No

What is your connection to Multnomah County? *

When are you able to meet?

Daytime

Weekdays

Evenings

Weekends

Why are you interested in the MCCED Board? *

What is your area of expertise? Or what kind of contribution can you make to the board? *

Do you have other volunteer commitments? *

Please list the name, address and phone number for two references. *

Please list the name, address, phone number and relationship for an emergency contact. *

Please state any potential conflict of interest you may have about any county department. *

Is there anything else you would like to share about yourself?

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