Dan Whalen Application W3f ,,,-
rS Fridley Civic Campus
- 7071 University Ave N.E. Fridley, MN 55432
Ciry of
Fridley 763-571-3450 I FAX: 763-571-1287 I FridleyMN.gov
Name D" 411 6( /1/4' 1-C✓ Go Q.)
Address // 6 7i C�T Al r�-t/c of "v r-3-6/lc).
Home Phone 765 3Y/1.7>7 Number of ears/ onths Resident of Fridley ):_3
Employer S T F +� NJ,A Work Phone wllL Rv11✓W �7/id"(
Address
Email
Please rank in order,the commissions on which you wish to serve.(Leave blank any Commissions
on which you do not wish to serve.)
Charter Commission :(1*
Housing & Redevelopment Authority
Planning Commission
Environmental Quality& Energy Commission
Parks& Recreation Commission
Prior Experience on City Commissions, City Boards, etc.:
Work Experience: /n(4/6tL kifi) 0-o .lo,,•r,402- Ct*-111^ f/-411-(4-G C
Civic, Professional and Community Activities: CO"d Cdf 14 ,V t S f0Arg
(Over)
Why do you want to be on a Fridley commission? U E� /c 7�' % tc%h m htii
What skills, strengths or abilities do you believe you will add to the commission?
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Does your work require you to travel? Aid d How often?
Additional Comments: A?P V ' 171/7'j
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References (Optional):
Name Address Phone No.
P7— P- ce FAIO Ley IV
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‘nature Date
The information provided by you on this application will be used to determine your suitability for
appointment to a City of Fridley commission. Participation as a commission member is strictly voluntary,and
you are not required by law to provide this information. If you do not furnish this information, however,the
City may have difficulty determining your suitability for appointment and contacting you. Under Minnesota
State statutes, only your name is considered public information upon appointment. Any other information
on this application is private data and will be accessible only to you,City staff or as provided for by Minnesota
statutes.
Please return the application to Roberta Collins,
City of Fridley, 7071 University Avenue N.E., Fridley,MN 55432.