Community Air Protection Program (AB617) Steering Committee Application

Would you like to help reduce air pollution in your community?

The Sacramento Metropolitan Air Quality Management District is looking for South Sacramento/Florin community members to serve on an Air Quality Steering Committee. This committee will work with the District to identify ways to reduce local air pollution and improve air quality in the South Sacramento/Florin community. Committee members may be eligible to receive a stipend.

Press next to complete the application.

Who is eligible to join the Committee?

You are eligible if you live, work at, or own a business within the South Sacramento/Florin community boundary, or if you are part of a community organization that operates within the community boundary (see map below)

Joining the committee is an excellent opportunity to:

Advocate for clean, healthy air in your community
Build connections with other committee members
Help reduce air pollution and improve the health of your neighborhood

If I join the committee, what is my commitment?

Attend monthly meetings (currently in-person with a remote option)
Encouraged to join a subcommittee and work with other members on specific projects
Serve for two years, with the option to renew

Air Quality Steering Committee Application

Where is the South Sacramento/Florin community?

The community boundaries are Broadway and Jackson Rd on the north, Mayhew Rd and directly south of the south terminal of Mayhew Rd on the east, Bond Rd/Laguna Blvd on the south, and Freeport Blvd and directly south of the south terminal of Freeport Blvd on the west.

Individual or Organization

Apply as an individual that lives, works at or owns a business within the community boundary

Apply as a community organization. If you are a community organization (i.e. school district, faith-based organization, business organization, or environmental justice organization) that operates within the South Sacramento/Florin community boundary and would like to be represented on the Committee, please provide the following organization information.

Name of Organization

Full Name of Executive Director/President

Title of Executive Director/President

Email Address

Phone Number

Executive Director/President Email

Executive Director/President Phone Number

About Your Organization

Please describe your organization's connection to the South Sacramento/Florin community and its members.

What experience does your organization have serving the South Sacramento/Florin community within the geographic community boundary shown above? Please briefly describe this experience.

Approximately how many members are currently in your organization?

If applicable, when was the organization established?

Please provide the following information for the person(s) who will serve on the Steering Committee as a representative of your organization

Primary Representative

Alternate Representative (optional)

Full Name of Primary Representative

Primary Representative Contact Information

Full Name of Alternate Representative

Alternate Representative Contact Information

Community Affiliation

How are you connected to the South Sacramento/Florin community?

I live here

I work at a business here

I own a business here

If you work at or own a business here, please provide the workplace or business name and street address

About You

Why do you want to serve on the Air Quality Steering Committee?

Are you connected to any organizations, clubs, teams, or groups in the South Sac/Florin community, and are any of these youth oriented?

Please list all affiliations that you have with community organizations and businesses:

What skills, experience, or knowledge will you bring to the Committee to help serve the community?

Are you age 18 or older?

Yes

Disclaimer and Signature

I understand that my volunteer application may or may not be approved by the District. If approved, any false or misleading information determined by the District in this application may result in my release as a member of the Air Quality Steering Committee. Applicant name, answers provided to questions and major cross streets will be made publicly available. Contact information such as email, phone number, and exact address location will not be made publicly available unless permission is given. Upon the approval of the application, additional information or documentation may be requested as part of the approval process for the Steering Committee.

Applicant Signature

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.