Form Center

By signing in or creating an account, some fields will auto-populate with your information.

Peoria City/County Joint Commission on Racial Justice and Equity - Application to Join Commission

  1. Preferred Method of Contact*
  2. Are you age 18 or older?*
  3. Are you currently serving on a City or County commission or committee? *
  4. The Racial Justice and Equity (RJE) Commission serves as the steering body for the overall RJE initiative. This commission guides the work, oversees the committees, collects and analyzes information, explores strategies, develops resources, and communicates progress via periodic reports to the Peoria City Council and Peoria County Board.
  5. Under the commission, there are multiple committees on which to serve. These committees are committed to working on action issues within our community with a racial justice and equity lens.
  6. Can you commit to monthly meetings, at least two hours per month?*
  7. What is your availability to meet?*
  8. As a member of the Commission, you will be expected to participate in specific racial justice and equity training, small group facilitator training, and open meetings act training. Are you willing to participate in this training?*
  9. Please complete the following as it relates to the relevancy of the commission/committee you are applying for:
  10. Electronic Signature Agreement*
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date. I certify that the above information is true and correct.
  11. Leave This Blank:

  12. This field is not part of the form submission.