Full Name:

Street Address:

City:

State:

Zip Code:

Home Phone:

Mobile Phone:

Email:

Are you a registered voter?
Yes No

Are you a resident of SCC District 4? Refer to this chart or the Nebraska Voter Information Lookup webpage.
Yes No

Have you been a resident of SCC's 15-county service area for the prior six months?
Yes No

Have you been a resident of SCC District 4 for the prior six months?
Yes No

Will you remain a resident of SCC District 4 if you are appointed?
Yes No

Are you an elected or appointed member of another public board relating to education?
Yes No

Are you an employee of Southeast Community College?
Yes No

What motivated you to apply to be a member of the SCC Board of Governors?

Discuss the skills/experiences you bring to the Board of Governors. Please include the educational and professional experiences that you believe are pertinent to being a member of this Board.

Discuss your beliefs and understanding relating to the role and mission that Southeast Community College plays in the 15-county service area.

Please describe any experience you have in serving on any other elected or appointed boards. How would this experience benefit you and the Board if you are chosen?