Office for Cultural Diversity Leadership Commission Application for Membership This application form requests information about your background, experience, and interest in becoming a member of one of the leadership commissions of the Office for Cultural Diversity. Please see the enclosed brochure to learn more about the role and responsibilities of commission members. Complete the form and answer the questions as fully as possible. Return the completed application form by SEPTEMBER 18, 2015 to: Lynette Saenz Office for Cultural Diversity Diocese of Rochester 1150 Buffalo Road, Rochester, NY 14624 Please check the appropriate box: Asian/Pacific Commission
Black Commission
Latino Commission
Name: Address: City/Town: Home Phone:
Zip: Work Phone:
E-Mail Address: Parish:
City/Town:
Type of Employment: We strive to be as balanced and inclusive as possible in our membership, reflecting the diversity of people who make up this diocese. Please indicate the following: Age:
Nationality/Racial Identity:
Please answer the following questions in the space provided or on a separate page: 1. What gifts would you bring to the Leadership Commission and how would you envision using them?
2. Tell us the reasons you would like to be on the Leadership Commission?
3. What are your current volunteer commitments to your local parish, community, and diocese?
4. Please list the name, telephone number, and/or email of two references (i.e., pastor, coworker, fellow volunteer, and/or friend).
