Jackson Area Transportation Authority Indication of Interest Form For Open Position on LTAC

Provide input, review and comment on the Vehicle Accessibility Plan as required by the Michigan Department of Transportation (MDOT).
Generate discussion, interpretation, and recommendations to the JATA Board regarding any senior adults and persons with disabilitiesrelated issues of a significant nature.
Work with JATA staff as directed by the JATA Board toward the achievement of the organization’s goals and objectives.
Report regularly to the JATA Board of Directors the activities, actions and recommendations of the Council.

Contact Information

Name*

First Middle Last

Phone*

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Representing*

Current Employer*

Current Position*

Years at current position*

Highest level of education completed*

Name of activity/organization*

Length of service*

Position(s) held*

Name of activity/organization

Length of service

Position(s) held

Name of activity/organization

Length of service

Position(s) held

Name*

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone*

Relationship*

Name*

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone*

Relationship*

Name*

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone*

Relationship*

Describe why you are requesting appointment to this council*