TDLCB Membership Application

Your Contact Information

Name*

First Last

Email*

Phone*

Home Address*

Street Address Address Line 2 City State ZIP Code

Employer

Work Address

Street Address Address Line 2 City State ZIP Code

County*

What county do you live in.

Date*

How long have you been a continuous resident of the above selected county?

Your Transportation Interests

Tell us about your transportation interests and habits.

How often do you use the LYNX bus system?*

Regularly
Occasionally
Not at all

How often do you use SunRail?*

Regularly
Occasionally
Not at all

How often do you drive a car?*

Regularly
Occasionally
Not at all

Do you have a passion for advocacy in any of the following areas (choose all that apply):*

Select seats you are qualified for and interested in filling (choose all that apply):*

Representing the elderly (over age 60)
Representing the disabled
ACCESS LYNX system user
Citizen advocate

Demographics

The following information will be used to satisfy Equal Opportunity Act reporting and research requirements. These questions are voluntary.

Gender

Female
Male
Other

Race

White
Black
Hispanic/Latino
American Indian/Alaskan Native
Asian
Native Hawaiian/Pacific Islander
Multiracial
Other

Do you have a physical disability?

Yes
No

Your age range:

Is your household income at or below U.S. Department of Health and Human Services poverty guidelines?

Yes
No

Are you a student?

Yes
No

Your Ability to Serve

The TDLCB meetings are generally held four times a year on the second Thursday of the month at 10:00 a.m. Can you regularly attend meetings?*

Yes
No

Can you serve a four-year term?*

Yes
No

Are you willing to abide by Florida’s Government-in-the-Sunshine laws and ethical guidelines?*

Yes
No

Have you previously served on a MetroPlan Orlando board or committee?*

Yes
No

If yes, which committee and when did you serve?*

Do you have any potential conflicts of interest that might occur if you are appointed?*

Yes
No

If yes, please provide details here.*

Please note: Applicants who work in the transportation industry or are currently elected officials cannot serve as members of the Community Advisory Committee, per committee bylaws.

Do you work in the transportation industry?*

Yes
No
Unsure

if so, please list why.

Are you an elected official?*

Yes
No

Statement of Interest

Please use the space below to describe your reasons for wanting to join the Transportation Disadvantaged Local Coordinating Board (TDLCB). This information will help us create a committee that reflects the diversity of Central Florida. Please limit your response to 500 words or less. In preparing your statement of interest, consider the following:

What type of role do you think you could play as part of the TDLCB?
What kind of feedback do you think you can provide to MetroPlan Orlando?
How would you update your community about what you learn as a TDLCB member?
What interests, personal qualifications or previous experience do you have that will help you be a productive TDLCB member?

By submitting this form, I attest that the information in this application is true to the best of my knowledge.

Comments

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TDLCB Membership Application

Your Contact Information

Your Transportation Interests

Demographics

Your Ability to Serve

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