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20.145 Edgardo Cancel ApplicationMayor of Northampton Mass. <mayor@northamptonma.gov> Online Form Submittal: Application for Appointment to Boards, Committees and Commissions noreply@civicplus.com <noreply@civicplus.com>Tue, Aug 30, 2016 at 12:29 PM To: mayor@northamptonma.gov Application for Appointment to Boards, Committees and Commissions City of Northampton Application for Appointment to Boards, Committees, and Commissions Please return the completed form to: Mayor@northamptonma.gov or David J. Narkewicz, Mayor 210 Main Street, Northampton, MA 01060 First Name Edgardo Last Name Cancel Title, if applicable Field not completed. Address1 19D Hampshire Heights Address2 Field not completed. City Northampton State Massachusetts Zip 01060 Home Phone Field not completed. Work Phone Field not completed. Cell Phone 413-387-2741 Occupation & Place of Employment Spanish Language Interpreter at Language Bridge, LLC Email canceledgardo@gmail.com Sex Male Years Lived in Northampton 27 years Age 40 - 49 Racial / Ethnic Background Puerto Rican Boards and Committees Community Preservation Committee, Housing Partnership, Human Rights Commission, Municipal Affordable Housing Trust Fund Board of Trustees, Parks and Recreation Commission Please list "other" board or committee of interest Northampton Housing Authority What skills and experience will you bring to this committee assignment? I grew up in a Northampton low-income household and understand the struggle and reality of facing homelessness in this area. I am a community organizer and over the years I have developed relationships with low-moderate income and public housing residents in Northampton through door to door outreach, community events, organized sports, and having worked in the Northampton Public Schools. In addition, I have served on the Valley Community Development board of directors, Cooley Dickinson Hospital Healthy Communities Committee, CDH Patient and Family Advisory Council, and Casa Latina, Inc. board of directors. Currently, I am the director of Hampshire Association of Tenants, Inc. (HAT) a new tenant organization in Northampton. Are you currently serving or have you served on any city committee? No Please list other city committees you have served on Field not completed. Required: Please read the following, by signing below you state that you understand and agree. The filing of this form does not guarantee my appointment. An application is kept on file for two (2) years; after that I must file a new application. Being appointed to a committee, board, or commission means that I am considered a Municipal Employee under MGL Chapter 268A and thereby subject to Conflict of Interest Law MGL Chapter 268A, Financial Disclosure Law MGL Chapter 268B, as well as Open Meeting Law MGL Chapter 39: Section 23B. I understand that I will take the conflict of interest test after being appointed and that I also must be sworn in by the City Clerk. I will contact the appointing authority with any questions about my service. Important: Once this form is submitted it becomes a public document, if there is information you do not want open to the public please do not include it on this form. Signature Edgardo Cancel Date 8/30/2016 [Quoted text hidden]