LPRAC-Talent Bank Form

Please provide the following contact information:

Prefix

First Name

Middle Init.

Last Name

Address

City

State

Zip Code

County

Home Phone

Work Phone

Fax

Email

Mailing Address

Address

City

State

Zip Code

County

Employment

Your Title

Company Name

Address

Address (cont.)

City

State

Zip Code

District Information

House District

Senate District

Most Recent Education

Degree

Institution

Area of Study

Year of Graduation

Additional Information

Please specify your political affiliation:

Democrat
Republican
Independent
Unaffiliated

Other Please Specify

Gender:

Male
Female

Are you a U.S. Citizen:

Yes
No

Are you a Registered Voter:

Yes
No

Are you a Lobbyist:

Yes
No

Are you an Elected Official:

Yes Please Specify
No

Race:

African-American
American Indian or Alaskan Native
Asian
Caucasian
Hispanic
Native Hawaiian or Other Pacific Islanders
Two or more races

What are your areas of interest/background for appointment:

AIDS
Arts
Children's Issues
Civil/Human Rights
Construction
Discrimination
Domestic Violence/Family Issues
Drug and Alcohol Prevention
Economic Development
Education
Elderly
Environment
Ethics
Financial Matters
Health/Medical Field
Historical Society
Housing
Human Services
Judicial Issues
Law Enforcement
Mental Health
Minority Rights
None
Prison Issues
Public Relations
Public Safety
Real Estate
Small Business
Social Services
Technology
Urban Issues
Veteran's Affairs
Victim's Rights
Women's Issues
Workforce Development

Other (please specify)