Westlake City Schools
Citizens Advisory Committee
Membership Application
Please fill out the following application, which is to be reviewed by the Superintendent and CAC officers. Applicants
are approved by the Board of Education prior to obtaining membership.
Personal Information
Last Name
First
Middle
City
State
Zip Code
E-mail Address
Telephone Numbers (Home)
(Cell)
Street Address
Position applying for:
 Research Associate – an annual ad-hoc position, up to three consecutive terms. Research Associate is a
streamlined position that allows the member become familiar with the CAC research process, but is not
obligated to fully participate in CAC activities and does not vote. A stepping stone to full membership.
 Entry Year Member – a one-time position to be fulfilled prior to becoming a core member. Entry year members
participate fully in CAC activities, but do not vote.
 Community Representatives – two year term, up to two consecutive terms. Community members participate fully
in CAC activities, but are not required to be residents and do not vote.
 Westlake High School Student Representatives – up to three year term with voting privileges.
 Core Member – two year term, up to three consecutive terms with voting privileges. Requires one year as a
Research Associate or Entry Year Member.
Why are you interested in serving on the CAC?
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Current Employer Information
Name of Employer
Your Title
Address
Phone
Job Responsibilities
Educational History
High School
Name/Address
Degree Received
Major/Minor
College/University
College/University
Clubs/Activities/Honors Received
Professional Experience
Starting with present, or most recent, employer, list all previous employers. If more space is required, please attach
an additional sheet.
No. of Years
From
To
Position/Title
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Organization
Duties
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Community Service/Civic Engagement
Please include past CAC membership, and any leadership positions. Include outside activities/organizations to which
you belong, excluding those indicating race, color, religion, sex, national origin, age, handicap, or Vietnam-era
veteran status.
No. of Years
From
To
Position/Title
Organization
Duties
Skills
These skills are often utilized or developed with CAC activities. Please evaluate your current level, and note that many
of these skills are further developed or refined with CAC participation.
Scale:
1
not interested
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2
aware
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3
basic
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4
intermediate
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5
accomplished
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Microsoft Word
Microsoft Powerpoint
Literature research skills
Brainstorming and
other group process tools
Synthesizing information
for report writing
Contacting and interviewing
external resources
Presentation skills
Project teamwork
Project management
Personal
Have you ever been convicted of a felony?  yes
 no
Spouse’s Name
Children’s Name(s)
Age(s)
School(s)
This application may be submitted online, or through the mail to the Westlake City Schools Administration Building,
27200 Hilliard Blvd., Westlake, OH 44145. Attn: Dr. Daniel Keenan
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