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OPTIONAL DEMOGRAPHIC INFORMATION <br /> In 1983, the City Council passes a resolution regarding its interest in appointing persons of diverse race, age, sex, <br /> and disabilities to citizen committees. By completing the following information, you help us assess whether <br /> appointments represent a broad cross - section of the community. <br /> Male Female Married Single Number of Children <br /> Age: Under 21 21 -34 35 -49 50 -65 Over 65 <br /> Race: Asian Black Hispanic Caucasian Native American Other <br /> Disability: Yes No If yes, describe: <br /> Fluent in language other than English? No Yes Describe: <br /> City Council Policies: <br /> City of Eugene employees: City Employees may not serve on City of Eugene citizen committees except as <br /> specifically provided by City ordinance or as required to perform official City duties. <br /> Public Information: Information submitted on this form shall be considered public information. <br /> Signature of Applicant Date <br />