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HomeMy WebLinkAboutApplicationsTown of Mansfield a¢ a, 11: To 6 Park Rom, Manoeld, Ma sachusetts 02048 Board of Selectmen ��fa ASA 96�P � 1 - Licensing Authority APPLICATION FOR CONSTABLE NAME ._"1• TELEPHONE Tl. — //_-..... An'. 1L 2©-2v q ®Z.6-3z STATEMENT OF MORAL CHARACTER OF APPLICANT (TO BE SIGNED BY FIVE REPUTABLE CITIZENS [OF TOWN RESIDENCE] INCLUDING ONE ATTORNEY) Name Address %f ��G7abvc �j/• �U�Zo✓eJGy rr/. Name Add ess ae�l sT a��✓s BAD �M7 N v Address / 0, ���a��,� �M A A C ►7 i� N � V CR.Iss Addrrt\e,Y\ S0 Jfr< lux Nam -� Address M 0-L S S J NOTE: All applicants shall be subject to a criminal record check by the Selectmen's Office. REMARKS: (Approved) (Disapproved) Chief of Police Date Phone (508)261-7372 Fax (508)261-74P8 Email .celedmen@manoeldma.cow r-- ()rutrnOtur MA(/ PLYMOUTH COUNTY POLICE CHIEFS' ASSOCIATION March 21, 2020 Chief Scott Alien East Bridgewater Police Department P.O. Box 475 East Bridgewater, MA 02333 Dear Chief Allen, Please be advised that the following officer (s) have attended and successfully completed Reserve In -Service Training for FY 20 on the dates listed below. Courses completed: CPR/AED, First Responder, Police Survival, Criminal Procedures, Protocols and Investigation into Animal Cruelty, Legal Issues I & Il, Defensive Tactics: RIS 4 NIGHT March 9-14, 2020 Joel Thomas Please feel free to contact my office if you have any questions. I can be reached at 508-830-6365. Respectfully, Jo n A. DeGutis, Jr. Pr Aram Administra 24 Long Pond Road • Plymouth, MA 02360 0 508-830-6365 C %' lie /7I&iIICCa.4/1 PLYMOUTH COUNTY POLICE CHIEFS' ASSOCIATION April 4, 2019 Chief Scott Allen East Bridgewater Police Department P.O. Box 475 East Bridgewater, MA 02333 Dear Chief Allen, Please be advised that the following officer (s) have attended and successfully completed Reserve In -Service Training for FY 19 on the dates listed below. Courses completed: CPR/AED, First Responder, Multi Agency Response to Active Shooter (ASHE), Integrating Communication, Assessment and Tactics (ICAT), Legal Updates, Defensive Tactics and Police Interactions with Persons with Mental Illness — Part II: RIS 4 NIGHT March 25-30, 2019 Joel Thomas Please feel free to contact my office if you have any questions. I can be reached at 508-830-6365. Respectfully, 2�-- 3,C", Jo n A. DeGutis, Jr. P ogram Administrator 24 Long Pond Road 0 Plymouth, MA 02360 March 15, 2018 Chief Scott Allen East Bridgewater Police Department P.O. Box 475 East Bridgewater, MA 02333 Dear Chief Allen, Please be advised that the following officer (s) have attended and successfully completed Reserve In -Service Training for FY 18 on the dates listed below. Courses completed: CPR/AED, First Responder, Procedural Justice: Legitimacy, Critical Incident Stress Awareness, Legal Issues I & II, Combating Extremism/Radicalism, Domestic Violence and Defensive Tactics: RIS 3 NIGHT March 5-10, 12, 13, 14, 2018 Joel Thomas 'FIREARMS is mandatory to complete FY 18 Reserve In -Service Training. Please forward officers' qualifications when completed. A separate letter will be sent upon firearms completion. Please feel free to contact my office if you have any questions. I can be reached at 508-830-6365. Respectfully, _7 - . A n A. DeGutis, Jr. gram Administrat r. PI,Y1b.IOUi'H COUNTY POLICE MASSACHUSE1 p` March 20, 2017 Chief Scott Allen East Bridgewater Police Department P.O. Box 475 East Bridgewater, MA 02333 Dear Chief Allen, Please be advised that the following officer (s) have attended and successfully completed Reserve In -Service Training for FY 17 on the dates listed below. Courses completed: CPR/AED, First Responder, Dynamics of Addiction, Effective Interventions with People with Alzheimer's & Silver Alert, Legal Issues I & II, Effective Police Interaction with Youth, Active Shooter, and Defensive Tactics. RIS 4 NIGHT March 6-11, 13, 14, 15, 2017 Joel Thomas *FIREARMS is mandatory to complete FY 17 Reserve In -Service Training. Please forward officers' qualifications when completed. A separate letter will be sent upon firearms completion. Please feel free to contact my office if you have any questions. I can be reached at 508-830-6365. Respectfully, r- ohn A. DeGutis, Jr. rogram Administrator Town of Mansfield Rug -E� &WFICE Application to Serve on a Board, Conm>I� , Committee or Study (;MuRC _4 A g: 28 Name: oLi.iSynoy(45o Date pp II n Address: U�r7vo k5, �e PY, Telephone No. (Home) 1; b — 3 `� —� 7 4� (Cell) E-Mail Address: et yit cv r' L� $ o 4 A /• Co h Are you a registered voter in Mansfield? Yes No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health I� tether: k,6 e L, Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. I i 1� C= t/� B. 3. Why do you want to serve on this part 4. Please state three attributes you can r. Board, Committee, or Commission? to this Board, Committee, or Commission. AI Have you attended any meetings of this Board, Committee, or Commission? (Optional) yes —C, rV`C n-- w.o.mle✓- 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? 7. What is your availability? Nights? Weekends? k 8. Do you regularly attend Town Meeting? Yes �No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes A/' No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. r�<77 koA �scti`s+.i Dates: q(o tL.G5 B. I7uccry/lo� Sr�ec�w.eK Dates: xra✓' -. 11. Please list your present employer: (Optional) Employer: / / Position: n C�iy)iLe ( iG.inGZ baS �ytL �O�Ceylee4-0 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. 13. Education Background Name and Location Graduated Degree(s) 1 I (Yes or No) p High School: WGS4-V/,, (/f�j o Q j6 1 I l (yrit�Q �Wk - ye $ College: h'_V C v5SJ WvrGeSC-er %!d �vS 'yS61nem Other Secondary: 96 5 4o 1, Cy �l e h t CkeS�hk 14. Please list any professional affiliations (Optional): 15. Please list any other specialized ,, interests and hobbies (Optional): �Ni oli IYu V"n`o't1 Ae �io-el-y �P' ati aVpcf cce.c ovr; A n✓ �.l ,.r.. like M..ut. ..1 16. Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Cleric, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Se Revised 3/21/13 per BSO Vote of 3/20/13 Town of Mansfield Application to Serve on a Board, Commission, Committee or Study Group Name: �antd onUcc6' Date J '- F'A- d�y Address: ( �S� rS�l((1��� ear rah Telephone No. (Hone) (Cell) E-Mail Address: I> ayI N , �h 1 �11 i `ui� I _ I 1. Are you a registered voter in Mansfield? Yes X No Town Boards, Commissions, Committees: Airport Coramission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: 1( Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. erof Please mark your two choices in order of preference: 4. Please state three attributes you can bring to this Board, A � r a 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? 0 7. What is your availability? Nights? Weekends? TS04- n 8. Do you regularly attend Town Meeting? Yes No wue riot a+-+ s x�ecR -F©ti� cxu�h�le d�� �i i t 0(k►nq wo� +xj)" 9. Have you ever served on a Board, Committee, or Comnissinn in. the Town of Mansfield? Yes No 10, If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. Dates: B. Dates: I1. Please list your present employer: 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. a�� Vv t tbrk o s a. ftam Pki'r. 13. Education Background: Name and Location Graduated Degrec(s) /i , y� t' (, 6 G (Yes or No) High School: eff� l'� �l i 1 l�Y r <JUi'�tJ 1j College: �`"V+'�614 �G IF � 5✓ VV Other Secondary: 14. Please list any professional affiliations (Optional): 4Y Nl � Vt U yr Y' v t �P�41h {� Yi• V1%V1 � %� ryl �zYlinf�t%t^_P is, Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpful while reviewing your application. J f Ve, 11\/ cd i vt,. VAaA/ SA-61d -P&--ltk- . ha C-- 69 wrwe io n i9w�pp1 c qee, 0,+ +AA-+,140.6i d- 34WAi� ,, j uj-11,41,0& Comm"VvoCOACA wowiJ, (a6"W '' ll I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of -lr I lt5 (-10XVI ) Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. 4— llla,�Vlaill tgnatu Revised 3/21/13 per BSO Vote of 3/20/13 Town of Mansfield vU ` 4" ..." ion to Serve on a Board, Commission, Committee or Study Group Name: Neal A. aoadghhini Datell/14/20 Address: 660 East at:, Mansfield, MA 02048 Telephone No. (Home)'bgeaaaag6g (Cell) 50ea5e-4695 E-Mail Address: chlefb0ld2007@Jgmail.com 1. Are you a registered voter in Mansfield? Yes - No _ Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee" Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. Council on Aging B. 3. Why do you want to serve on this particular Board, Committee, or Commission? I have been woNng with the council on Aging for over twenty years and have been able to be part of the development of many programs and Initiatives will allow me to do so. 4. Please state three attributes you can bring to this Board, Committee, or Commission. 1 bring a comprehensive understanding of the agency, a strong working relationship with director and a passion for helping the senior population.' 13, Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: Mansfield High School College: Southeastern Massachusetts University. yes BA, History Other Secondary: 14. Please list any professional affiliations (Optional): 15. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpful while reviewing your application. I was born and raised in Mansfield at a time when it was still may a small town. It always fell like there was always someone looking out for you and helping you, in some way, always stay safe and help you navigate a path to becoming a better person. I feet a great responsibilty to give back to Nose who looked out for me and working with the senior population in a time in which they may now need my help, has always seemed like the right thing to do. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest" provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Signature Revised 3/21/13 per 1980 Vote of 3120/13 h agAxar A� 4 i a Town of Mansfield EeASAO�`� Application to Serve on a Board, Comrpissjilm, ? Committee or Study Group Name: Joel Brandwine Date 11A312020 Address: 296 Fmit Street, Mansfield, MA 02048 Telephone No. (Home) (Cell) 914-907-0716 E-Mail Address: iabmnawlne@gmall.com Are you a registered voter in Mansfield? Yes x No Town Boards, Commissions, Committees; Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. Airport Commission 10 3. Why do you want to serve on this particular Board, Committee, or Commission? I have been on the commission for 4 years. I feel as though there is still much work to be done and my time Is not yet up. I worry that leaving the commission at this juncture would create havoc as we are In the midst of multiple projects that need continuity. Aside form that, I have forged relationships with the FAA and MassDOT Aeronautics and want to use those to the town's advantage. 4. Please state three attributes you can bring to this Board, Committee, or Commission. I am attentive, listen, and flexible. I will ensure that these attributes will benefit the commission and the pilot based community to create an open dialogue and make sure the commission is working for them and not in our own self interest. t , 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) Yes, I am currently the chair of the commission. 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? Yes. I think that accounting needs to be jobbed out. It is too much for a volunteer position. I would like to see the commission begin to focus more on the airport proper and away from FAA mandated projects. There is too much differed maintenance and we need to work for our piloting community to ensure the airport is as up to date and as safe as possible. As for the Mansfield community, I would like to see some of the older buildings refurbished or replaced to keep Mansfield looking beautiful. 7. What is your availability? Nights? Weekends? I am available on most nights and weekends. I have some conflicts during the school year but aside from that I have flexibility in my schedule. Additionally, my summers are relatively light so I can focus much more on the commission during those months. 8. Do you regularly attend Town Meeting? Yes x No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes x No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. Airport Commission Dates B. Dates it. Please list your present employer (Optional) Employer: Position: Boston University Assistant Professor 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. My father is a general aviation pilot, my brother is a commercial pilot. I grew up with aviation as a conversation at the diner table. Additionally, 1 am well versed in giants and grant writing which Is a large part of the Commission's job. 13. Education Background: Name and Location Graduated Degrees) (Yes or NO) High School: Cherry Hill High School East, Cherry Hill, NJ 08003 Yes College: Boston University, 1 Silber Way, Boston, MA 02215 Yes BEA Other Secondary: 14. Please list any professional affiliations (Optional): United States Institute of Theatre Technology United University Professionals International Alliance of Theatrical Stage Employees OSHA 15. Please list any other specialized interests and hobbies (Optional): Home Improvement, Basketball, hiking 16. Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Signature Revised 3/21/13 per BSO Vote of 3/20/13 §QEp1NCI �� r a Town of Mansfield 9� ^ ! - E °��s.n5`` Application to Serve on a Board, Commission,, Committee or Study Group A 593 Name: an L� - d �— Date Address: Telephone No. (Home) � / �G y �/-/ (Cell) E-Mail Address: 1. Are you a registered voter in Mansfield? Yes No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission �Tiru�s�teleelso ent Commission Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. A. Please mark your two choices in �,bia ✓ / j'V�� order of preference: B. 3. Why do you want to serve on this particular Board, Committee, or Commission? 4. Please Mate three Attributes yqu can Prjng to this Board, Committee, or Commission. =r n 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? 7. What is your availAbIlity? Nights? Weekends? S. Do you regularly attend Town Meeting? Yes V No 9. Have you ever served on a Board, Committee, or Commission ' the Town of Mansfield? Yes V No _ peg 2. i'2Vfwec Cbmiderd 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: � �" A. l ibrdr rl a y s tee, Dates: B. Dates: 11. Please list your present employer: Q (Opttion%alb) c / /� / (� / /{ ENI/�Y).�,4 k C"00/S Position: re�i/4�%� I-1!0ci/E L �C�1l�o r 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. P7 13. Education Background: Name and Location Graduated (Yes or No) High School: College: Other Secondary: m ONl J' ( P I U 14. Please list any professional affiliations (Optional): 15. Please list any other specialized interests and hobbies (Optional): Degree(s) 16. Please provide any additional information you feel may be helpful while reviewing your application. 19 I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest" provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Revised 3/21/13 per BSO Vote of 3/20/13 ICI J�C1G'hce) 1pEG11�0/ ��' o ; E019AV15 Name: Alfred Mitchell Bregn Address: 134 Branch Street Town of Mansfield Application to Serve on a Board, Commission, Committee or Study Group r, ", C I: Telephone No. (Home) 508-212-5935 E-Mail Address: albregnard58@gmail.com Date 11-20-20 (Cell) 508-212-6935 Are you a registered voter in Mansfield? Yes X No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. Recreation Commission B. 3. Why do you want to serve on this particular Board, Committee, or Commission? I serve now and find it worhtwhlle 4. Please state three attributes you can bring to this Board, Committee, or Commission. Leadership, teamwork, respect for town values r 5. I -lave you attended any meetings of this Board, Committee, or Commission? (Optional) I serve as a commisioner 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? none at this time. 7. What is your availability? Nights? Weekends? I serve on the board now and their meetings and events fit my schedule. 8. Do you regularly attend Town Meeting? Yes No X 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes X No 10, If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. Recreation Dates: 2014 -current B. Dates: 11. Please list your present employer (Optional) Employer: Position: Quest Diagnostics Molecular lab assistant (COVID 19 sampling) 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. I built a adtabase for the fishing dreby, I am a public speaker for the board as needed (Duck Race) 1 13. Education Background: Name and Location High School: Mansfield High School College: Northeastern University Other Secondary: UMass Boston 14. Please list any professional affiliations (Optional): Graduated (Yes or No) Degree(s) 'ollege prep BS Civil Engineering MBA 15. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Cleric, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Revised 3/21/13 per BSO Vote of 3/20/13 AIBREGNARD ovvrv.areaaz owPoo Signature M ,p,C1HCr a Town of Mansfield c $9yaeeA3 A0v`'n4 Applicati6h to Serve on a Board, Commission, 1 01 "mmittee or Study Group Name: Dianaaren -.. Date 08.19.2020 Address: 66 Samoset Ave Telephone No. (Home) 617-899-3919 (Cell) same E-Marl Address: diana.bren@yahoo.com Are you a registered voter in Mansfield? Yes x No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. Cultural Council B. 3. Why do you want to serve on this particular Board, Committee, or Commission? Sitting on the planning board as a cifizen at large for the master plan has opened my eyes to wanting to continue to be part of the towns changes to come over the next several years. I have enjoyed the ability to look at opportunity and speak to the pros and cons of it and then making decisions for Mansfield. i would like to bring the perspective of a women who works and lives in Mansfield as well as is raising two young children is and 4) to the cultural council 4. Please state three attributes you can bring to this Board, Committee, or Commission. Continuous Improvement Mind Set- I am a Six Sigma Blackball and Ilke to look at the whole picture and get Ideas out of people using brainstorming sessions or non canvengonai meetings Dedication - I put 100 % Into what i sign up for, I am 100 % for managed as I work and live here and raising a family Young Parent Mlndset- I hear what the 30/40 somethings are saying and am one 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) None to date 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? Creative thinking and discussion -brainstorming Team building to understand personalities and how to all work efficiently together while having varying opinions understanding public perception and awareness MArket to get more people to attend 7. What is your availability? Nights? Weekends? Both - as needed to support this committee 8. Do you regularly attend Town Meeting? Yes X No kOut wau"rut 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes X No 10, If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A, Citizen at Large- Planning Board Dates: April 2019-present B. Just appointed as an alternative to the Planning Board Dates: July 2020 11. Please list your present employer: (Optional) Employer: Position: TriMark Corporate Direction, Master Date Management 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. Black Belt Six Sigma Certified, Communications Undergrad and Organizational Managemeni/Leadership Master. 1 have been president of the mansfeld women of today In the past (2 separate 1 year terms) i sit as a parent advisor on the pyramid leadership team at roland green I am part of the District Return to School Teaching & Learning Advisory Committee, June/July 2020 r 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: Bishop. Peehan Attleboro MA - Yes HS Diploma College: New England College, Henniker NH Other Secondary: New England College, Henniker NH Yes BS in Communications/PR YES MS, Organizallonal Management and Leadership 14. Please list any professional affiliations (Optional): 15. Please list any other specialized interests and hobbies (Optional): Being Involved with my kids and there Interests/activities (Dance, Theatre, Soccer, Softball, Rugby, Tumble, Art) I take an adult tau class 1X a week at night and spin 3 mornings a week (5:15 class!) 16. Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Revised 3/21/13 per BSO Vote of 3/20/13 Diana Bren �--•• Signature Town of Mansfield Application to Serve on a Board, Commission, Committee or Study Group Telephone No. (Home) 617-699-3919 E-Mail Address: diana.bren@yahoo.com 6.15.2020 (Cep) same a 1. Are you a registered voter in Mansfield? Yes X No n _w Cr Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: F"z Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. Planning Board B. Cultural Council ;n t.n 0 3. Why do you want to serve on this particular Board, Committee, or Commission? Silting on the planning board as a citizen at large for the master plan has opened my eyes to wanting to continue to be part of the towns changes to come over the next several years. I have enjoyed the ability to look at opportunity and speak to the pros and cons of it and then making decisions for Mansfield. 1 would like to bring the perspective of a women who works and lives in Mansfield as well as is raising two young children (6 and 4) 4. Please state three attributes you can bring to this Board, Committee, or Commission. Continuous Improvement Mind set- I am a Six Sigma alackbelt and like to look at the whale pletum and at Ideas out of people using bralnstorming sessions or non conventional meetings Dedication - I put 100% Into what I sign up for, I am 100 % for mansfield as ]work and live here and raising a family Young Parent Mindset- I hear what the 30/40 somethings are saying and am one 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) Yes, all but one as citizen at large (due to a family wedding) 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? Creative thinking and discussion- sticky notes and large brainstorming like the consulting firm Team building to understand personalities and how to all work efficiently together while having varying opinions understanding public perception - what body laguage and tone are used and how Is that perceived by the audience (live and on TV) MArket to get more people to attend 7. What is your availability? Nights? Weekends? Both - as needed to support the need of the board an town 8. Do you regularly attend Town Meeting? Yes x No 9, Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes X No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. Citizen at Large - Planning Board Dates: April 2019-present R3 Dates: 11. Please list your present employer: (Optional) Employer: Position: TriMark Corporate Direction, Master Data Management 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. Black Belt Six Sigma Certified, Communications Undergrad and Organizational ManagemenULeadership Master. I have been president of the mansfield women of today In the past (2 separate 1 year terms) 1 sit as a parent advisor on the pyramid leadership team at roland green I am part of the District Return to School Teaching & Learning Advisory Committee, June/July 2020 13. Education Background Name and Location Graduated Degree(s) (Yes or No) High School: Bishop Feehan Attleboro MA Yes HS Diploma College: New England College, Henniker NH Yes BS in Communications/PR Other Secondary: New England College, Henniker NH YES 14. Please list any professional affiliations (Optional): MS, Organizational Management and Leadership 15. Please list any other specialized interests and hobbies (Optional): Being involved with my kids and there interests/activities (Dance, Theatre, Soccer, Softball, Rugby, Tumble, Art) I take an edultjazz class 1X a week at night and spin 3 mornings a week (5:15 ciess0 16. Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Diana Bran -- ••-•- Signature Revised 3/21/13 per BSO Vote of 3/20/13 IVEO Town of Man KS OFFICE Application to Serve ogp?6�2grj� Cmr!� Zion, Committee or Study Group A'� 1 S �:I E L p M Chi SE FTS Name: Diana Bren Date 2.62020 Address: e5 Samoset Ave Telephone No. (Home) e17-899-3919 (Cell) same E-Mail Address: diana.bren@yahoo.com Are you a registered voter in Mansfield? Yes x No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. Planning Board U 3. Why do you want to serve on this particular Board, Committee, or Commission? Sitting on the planning board as a citizen at large for the master plan has opened my eyes to wanting to continue to be pall of the towns changes to came over the next several years. I have enjoyed the ability to look at opportunity and speak to the pros and cons of it and then making decisions for Mansfield I would like to bring the perspective of a women who works and lives In Mansfield as well as Is raising two young children (e and 3) 4. Please state three attributes you can bring to this Board, Committee, or Commission. enormous Improvement Mind Set - I am a six Sigma Blackbelt antl like to look at the whub acWm and at Wens out of people usbg bralnstonNng sessions or non conventional meetings Dedication - I put 100% Into what i sign up for, I am 100% for mansfield as I work and live here and raising a family Young Parent Mindset- I hear what the 30140 somethings are saying and am one 5, Have you attended any meetings of this Board, Committee, or Commission? (Optional) Yes, all but one as citizen at large (due to a family wadding) 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? Creative thinking and discussion - sticky notes and large brainstorming like the consulting arm Team building to understand personalities and how to all work efficiently together while having varying opinions understanding public perception -what body laguage and tone are used and how is that perceived by the audience (live and on TV) MArkel to get more people to attend 7. What is your availability? Nights? Weekends? Both - as needed to support the need of the board an (own 8. Do you regularly attend Town Meeting? Yes x No M....") 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes x No 10, If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. Citizen at Large- Planning Board Dates: Ami12018-present l?A 11, Please list your present employer: (Optional) Employer: Position: TrlMark Master Data N Dates: 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. Black Belt Six Sigma Certified, Communications Undergrad and Organizational ManagementTeadership Master. i have been president of the mansaeid women of today in the past (2 separate 1 year terms) i sit as a parent advisor on the pyramid leadership team at roland green 13. Education Background: Name and Location High School: Bishop Peehan Attleboro MA College: New England College, Henniker NH Other Secondary: New England College,Henniker NH YES 14. Please list any professional affiliations (Optional): Graduated Degree(s) (Yes or No) Yes HS Diploma Yes BS In Communications/PR MS, Orgenl¢alionai Managameni and l eadamhlp 15, Please list any other specialized interests and hobbies (Optional): Being involved with my kids and there interests/activities (Dance, Theatre, Soccer, Softball, Rugby, Tumble, An) I take an adult Jazz class 1X a week at night and spin 3 mornings a week (5:15 classl) 16. Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute, Diana Bren „ Signature Revised 3/21/13 per BSO Vote of 3/20/ 13 RECEIVED J vv > C .f_R S OrFICE IQWO JAN T6wPbGW4ktsf1e1d Appli jtioh',46&616 Bn a Board, Commission, �et� ntl ifti8FokREudyGroup Name: 1� k tolP 2)40'1 Date_ i u 12 C' Address: 51 FGttr-^e((. RA.yK- Telephone No. (Home) (Cell) (oN -5� �)�/ ` I(, ?+`Mail Address: -VA i c-D f F . L- 6 LA r L to, (e—) GI wLa t t 1. Are you a registered voter in Mansfield? Yes ✓ No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. CLh&t�&Ybit Couvu; } B. OC'VLVuOL) Y-,,,'z ri do you want to serve on this particular Board, Committee, or Commission? 4. Please state three attributes you can bring to this Board, Committee, or Commission. 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? w Elm.._ Iv iNQ4 tu�ttV VVwJ-)9,-s ck ,t< ""tea -ln. 7. What is your availability? Nights? Weekends? �hL4ta'tti� N- t�Jed €u�vtw�; - 8, Do you regularly attend Town Meeting? Yes -_S / No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes ✓ No — 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. 0, —' Ar(c..J Dates: Q 11. Please list your present employer: (Optional) Emolover: Position: Dates: 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: (i"G��{ l%),CyJ `�P`S ('d(Jiobc�tL� �lSt �f re�tn /A�ivsCQ , lz-A College: LLyyItwlf\, t Other Secondary:_ LZj�rQ �IYIE C'r<i6.hi. ih�Ab`�ht,1�f 4/0 ifi CAL(( 14. Please list any professional affiliations (Optional): 15. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. �� tc Ala, Signature Revised 3/21/13 per BSO Vote of3/20113 Town of Mansfield i-; lCE Application to Serve on a Board, Commiss,'pq,,` 32 Committee or Study Group rJ �, 4 Name: JOSEPH CERRETANI 55 SOUTH MAIN STREET Telephone No. (Home) 617-212-9341 E-Mail Address: loe.cermMmI@,mal.com Date 10/22/2020 (Cell) 617-212-9341 1. Are you a registered voter in Mansfield? Yes x No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Cormnittee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A, PLANNING BOARD 0 3. Why do you want to serve on this particular Board, Committee, or Commission? I have served oa the Planning Board for the past 5+years. I would like to continue serving the Town of Mansfield in this capacity. We have approved a new and very dynamic Master Plan and have made some very important Zoning changes that will help the town move forward and realize its potential, I mink the next &10 years will be very transformational for the Town of Mansfield and I would like to be there to help steer that transformation to be as beneficial to the lawn and its residents to the best of my abilities. 4. Please state three attributes you can bring to this Board, Committee, or Commission. The 3 main attributes I bring to this committee are as follows: i) I am a commorclal and residential RE Pmpany owner/manager, developer and licensed Realtor and have extensive knowledge of the Real Estate Market and how ours and other municipalities handle zoning, 2)1 have sal an the Planning Board for 5+years and have an In-depth kowledge of hour the process works and a track record of making hard declslons for the residents of Mansfield, and 3)1 have been an active and proud resident of the Town of Mansfield for 19+years and have a good understanding of our community and its residents and what that wants to be. 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: Melrose High School, Melrose, MA YES HIS Diploma College: UNIVERSITY OF VERMONT, BURLINGTON, VT YES BA ECONOMICS Other Secondary: 14, Please list any professional affiliations (Optional): LICENSED REALTOR,NAR, MAR, RASEM; TRI-TOWN CHAMBER OF COMMERCE 15. Please list any other Specialized interests and hobbies (Optional): FAMILY, SKIING, BOATING, TRAVELING, HIKING 16. Please provide any additional information you feel may be helpful while reviewing your application. I AM OPTIMISTIC WITH THE DIRECTION THAT THE TOWN OF MANSFIELD IS HEADED BUT REALIZE THAT THINGS CAN CHANGE IN A HURRY AND WOULD LIKE TO CONTINUE WORKING TOWARDS RESPONSIBLE GROWTH OF OUR COMMUNITY INTO THE FUTURE. THANK YOU FOR YOUR CONSIDERATION I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest" provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. i ature Revised 3/21 /13 per 13SO Vote of 3/20/13 Town of Mansfield R EIV 0 Application to Serve on a Board, Cotnuil sfon, ` r t',.= F I CE Committee or Study Group P1 20 P 12: 02 Name: LeeAnn Cerretani 55 South Main Street, Mansfield, MA 02048 Telephone No. (H) E-Mail Address: 508-954-2621 lecaiin.cerretaiii@gniail.com gmail.com 1. Are you a registered voter in Mansfield? Date April 20, 2020 Sl" i 1_I1 (w) Yes Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A Mansfield Council on Aging B. 3. Why do you want to serve on this particular Board, Committee, or Commission? In addition to being Master level Social Worker and have worked with Seniors for over 15 years. I have older parents, and feel I have insight from a professional background as well as a personal one as to what types of services might be beneficial to our aging population Housing is also a direct need of our aging population. I have receently obtained my Realtors license to also assist Seniors with downsizing and navigating what can be an emotional and scary time in ones life. I feel the combination of my skills and experience makes me a strong candidate for both committees and will allow me to give a little back to my community. 4. Please state three attributes you can bring to this Board, Committee, or Commission. I am a thoughtful and c and try to make the bes [low it through and can on to do so. I prefer to listen to those who will be affect by actions sed on this feedback. When I make a commitment I 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) I have attended a meeting of the COA Board. I was very impressed by the members on this Board and I feel I would make he able to work very nicely with all Of m. 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? I would need to have more information and have time listening to the the goals & objectives objectives before commenting. 7. What is your availability? Nights? Weekends? My job allows me flexibility for days, nights and weekends, 8. Do you regularly attend Town Meeting? Yes X No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes No X 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. 0 Dates: Dates: 11. Please list your present employer: (Optional) Employer: Position: SHEEHAN HEALTH GROUP CLINICAL LIAISON, LCSW, M.ED. JACK CONWAY REATTOR 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. I've worked with Seniors for over 15 years in the capacity of a Social Worker and Clinical Liaison. In this role, I have educated Seniors about Medicare and Medicaid short term and long term care benefits. I have facilitated family meetings around transitional care from home to nursing home; from nursing home to other levels of housing besides a person's home. I have Dracticed as a mediator with familv members and their Parent. I have also helned identified if it is safe for a Senior to return home with proper supports. On the fun side, I have coordinated and lead many group activities for seniors in multiple senior centers across the state from balance assessments to downsizing presentation to discussions around the need for a Healthcare Proxy, to name a few. Lastly, I have worked with many Seniors around identifying places to live that would better suit their aging self and budget. 13. Education Background Name and Location Graduated Degree(s) (Yes or No) High School: Stoughton High School 1986 Yes Diploma College: Suffolk University Yes BS Other Secondary: Boston Univeristy YES MEd. MSW 14. Please list any professional affiliations (Optional) ureaier nos[on neat nscare noara National Association of Social Workers 15. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Signature Revised 03/21/13 Per BSO Vote of 03/20/13 -A I v �4lNC! b' Town of Mansfield -FICL p"FCASAO`�Q4 Application to Serve on a Board, Commission, Committee or Study Group ' 2 C` S Name: 54 1 -- 40�-Vp Date 0 Z Address: 30 (// Telephone No. (Horne) �� 3 �9 /�.�}/�3 /Q (Cell) E-Mail Address: 1. Are you a registered voter in Mansfield? Yes —Y No Town Boards, Commissions, Committees: Airport Commission elfare Cortunittee Board of Assessors Cable Access Board of Directors ConservationCommission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee' 2. d Please mark your outwo choices in order of preference: / - A. rII& -CeAej4'6,. B. 3. Why do you want to serve on this particular Board, Committee; br Commission? �/h d� ✓E-7re Li AX-f�I�.�-� //S G� E D� i.��G3.. ,P.LSauiGCe r�y�QeylZlii2 �-� _�.I�— 4. Please state three attributes you can bring to this Board, Comrnittee, or Commission d ✓e-7-E/Z(A-r' t l2 �v✓ t E* CC 2�A -eSS -T 7n V0eA1ALS *- �it/Fe2in/.4 Two it l ,� 5les c.o d1 �S'a RVice - 13. Education Background: Name and Location Graduated Degree(s) / �/ (Yews or No) p /q p�j High School: "V G l /t c� —5 �w—CTL Ogg College: I le Other Secondary: I V T t .i V-" �I3✓P I)VI-AILI 14. Please list any professional affiliations 15. Please list any other specialized interests and hobbies (Optional): i 16. Please provide any additional information you feel may be helpful while reviewing your application Zd2E7 I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of lnteresf" provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Signature Revised 3/21/13 per BSO Vote of 3/20/13 �. vptc xw �� < e Town of Mansfield Application to Serve on a Board, Commission, Committee or Study Group �" C. Name: 74 Date // /���►Z, Address: /,S' �izirilt </E of{S �Q i�� Telephone No. (Home) ,S y (Cell) 6 / % — '19 -V — 0 a s 9 E-Mail Address: / el Are you a registered voter in Mansfield? Yes /-'� No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. 1-4 L jsB. Why do you want to serve on this particular Board, Committee, or Commission? 4. Please state three attributes you can bring to this Board, Committee, or Commission. a 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? 7. What is your availability? Nights? Weekends? 71 8. Do you regularly attend Town Meeting? Yes !/ No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. B. / �2/,mot l ��/�CrzS Dates: �2o/O — ,�d /..Q, 11. Please list your present employer: (Optional) Employer: Position: 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. cd -- e./,;r A"<� TrJ-- Z' e e.,Z `1-dii< 7'�%u� ems, 11;2:z --L G?OO��X/�7a-T� G'JU� �a /�L,- 7`7%/� /'��1�/y �v� /✓/q,C..�`, 13. Education Background: Name and Location Graduated (Yes or No) High School: College: Other Secondary: 14. Please list any professional affiliations (Optional): 15. Please list any other specialized interests and hobbies (Optional): , Degree(s) 16. Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest" provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Signature Revised 3/21/13 per 1380 Vote of 3/20/13 Town of Mansfield ijr r 10E G a, 10: 4 3 Application to Serve on a Board, Commission, Committee or Study Group Name: Eric D. Correira Date 1lt5t20 Address: 40 Jake. Way, Mansfield, MA 02048 Telephone No. (Home) (508)517-9142 (Cell) (508)517-9142 E-Mail Address: edc@correiralaw.com Are you a registered voter in Mansfield? Yes x No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. Zoning Board of Appeals B. 3. Why do you want to serve on this particular Board, Committee, or Commission? I have been a regular member of the Zoning Board of Appeals for the last ten months, and before that, an associate member for four years. I have enjoyed my time on the board, and think we have a good group that works well together and Is respectful toward one another and those that come before our board. My wife and I are raising our two sons In Mansfield, and I would like to continue to give back to the town by volunteering for the Board 4. Please state three attributes you can bring to this Board, Committee, or Commission. I believe that because of my background as a trusts and estates attorney and my now almost five years of experience on the Zoning Board of Appeals that I have strong analytical and reasoning skills, am a good communicator, and am able to work well and respectfully with others. 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) Yes, having sewed as both an associate member and now regular member. 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? No. 7. What is your availability? Nights? Weekends? Primarily nights, but also some availability on weekdays and weekends. 8. Do you regularly attend Town Meeting? Yes No X 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes X No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. Zoning Board of Appeals Dates: April 2016-present day Dates: it. Please list your present employer: (Optional) Employer: Position: Correlm & Coneira LLP Owner 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. See above. 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: Somerset High School, Somerset, MA Yes High School College: George Washington University, Washington, DC Yes B.A. Other Secondary: Villanova University School of Law, Vilianova, PA Yes J.D., LL.M. (tax) 14. Please list any professional affiliations (Optional): American Bar Association, Bristol County Bar Association, Bristol County Estate Planning Council, Collier County Bar Association, Florida Bar Association, Fall River Bar Association, Harvard Law School Federal Tax Clinic Pro Bono Panel, Mansfield Rotary Club, Massachusetts Bar Association, National Academy of Elder Law Attorneys, Newport County Bar Association, Norfolk and Plymouth Estate and Business Planning Council, Rhode Island Bar Association, Rhode Island Bar Association Bar Journal Editor in Chief, Rhode Island Bar Association Annual Meeting Planning Committee 15. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpful while reviewing your application. None. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Cleric, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Signature Revised 3/21/13 per BSO Vote of 3/20/13 RECE:iVED Town of Mansfield fOl��m E �t(S OFFICE Application to Serve on a Board, Commission BAN 13 A 10 13 Name: Edo n. coneim Address: 40 Jokes Way, Mansfield, MA 02048 Telephone No. (Home) (508) 517-9142 E-Mail Address: edc@correiralaw.com Committee or Study Group !S F IEL D I f; ,t.c uscTPS Date 1f8f20 (Cell) (508)517-9142 1. Are you a registered voter in Mansfield? Yes x No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. Zoning Board of Appeals B. 3. Why do you want to serve on this particular Board, Committee, or Commission? I have been an associate member of the Zoning Board of Appeals since 2016, and have learned a lot about zoning and the town over the last four years I have enjoyed my time on the board, and think we have a good group that works well together and Is respectful toward one another and those that come before our board. My who and I are raising our two sons in Mansfield, and I would like to continue to give back to the town by volunteering for the Zoning Board of Appeals. 4. Please state three attributes you can bring to this Board, Committee, or Commission. I believe that because of my background as a trusts and estates attorney and my now four years of experience on the Zoning Board of Appeals that I have strong analytical and reasoning skills, am a good communicator, and am able to work well and respectfully with others. 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) Yes g am currently an Associate Member) 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? No 7. What is your availability? Nights? Weekends? Primarily nights, but also some availability on weekdays and weekends 8. Do you regularly attend Town Meeting? Yes X No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes X No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. Zoning Board of Appeals Dates: April, 2016-present day B. Dates: it. Please list your present employer: (Optional) Employer: Position: Candice & Correira LLP Law Partner 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. See above 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: Somerset Hight School, Somerset, MA Yes High School College: George Washington University, Washington, DC Yes B.A. Other Secondary: Villanova University School of Law, Viilanova, PA Yes J.D., LL.M. (Tax) 14. Please list any professional affiliations (Optional): American Bar Association; Bristol County Bar Association; Bristol County Estate Planning Council; Collier County Bar Association; Florida Bar Association Fall River Bar -Association; Harvard Law School Federal Tax Clinic Pro Bono Panel; Mansfield Rotary Club; Massachusetts Bar Association; National Academy of Elder Law Attorneys; Newport County Bar Association; Norfolk and Plymouth Estate and Business Planning Council; Rhode Island Bar Association; Rhode Island Bar Association Bar Journal Editorial Board; Rhode Island Bar Association Annual Meeting Planning Committee 15. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpful while reviewing your application. None. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. r ` r gnature Revised 3/21/13 per BSO Vote of 3/20/13 CORREIRA & CORREIRA LLP ATTORNEYS & COUNSELORS AT LAW TOkNIA CLERKS OFFICE 1010im13 A10*13 r IA,NSFIc LD P9 .11 ACHl1SETTS January 8, 2020 Mansfield Town Clerk 6 Park Row Town Hall, Second Floor Mansfield, MA 02048 Re: Application for Zoning Board of Appeals Dear Clerk: 127 Dorrance Street Providence, RI 02903 401.454.5040 1415 Panther Lane Naples, FL 34109 239.649.5040 20 Park Plaza Boston, MA 02116 617.723.5040 20 Cabot Boulevard Mansfield, MA 02048 508.991,5040 1010 GAR Highway Swansea, MA 02777 508,679.5040 Enclosed please find my application for the vacant seat on the Mansfield Zoning Board of Appeals. If you have any questions, please do not hesitate to contact me. Very truly yours, r By: ric D. Correira, Esq. Enclosures pE0 Na ar � Name: Edo D.Cofrelfa Town of Mansfield IZEC("IVEG OFFICE 1U20 JAIj —8 P 2: 31 Application to Serve on a Board, Commission, Ic,,p�SL',.LD Committee or Study Group h/);�,r,`., '1111SETTS 40 Jokes Way. Mansfield, MA 02048 Telephone No, (Home) (eoa) 517.9142 E; Mail Address: Are you a registered voter in Mansfield? Yes x 1/8120 (Cell) (500)517-9142 No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Reep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. Zoning Board of Appeals B, 3, Why do you want to serve on this particular Board, Committee, or Commission? I have been an esa.clate member of the Zoning Board of Appeals since 2016, and have learned a lot about zoning and the town over the last four years I have enjoyed my time on the board, and think we have a good group that works well together and Is respectful toward one another and those that come before or board. My wile and 1 are raising our two sons In Mansfield, and I would like to continue to give back to the two by volunleedng far the Zoning Board .(Appeals. 4, Please state three attributes you can bring to this Board, Committee, or Commission. i believe that because army background as a Imsis and estates attorney and my now fouryears of experience on the Zoning Board of Appeals that I have strong analytical and reasoning skills, am a good communicator, and am able to work well and respectfully with others. S. Have you attended any meetings of this Board, Committee, or Commission? (Optional) Yes ((am currently an Associate Member) 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? No 7. What is your availability? Nights? Weekends? Primarily nights, but also some availability on weekdays and weekends 8. Do you regularly attend Town Meeting? Yes x No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes x No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A Zoning Board of Appeals Dates: April, 2016-present day B. Dates: 11, Please list your present employer: (Optional) Employer: Position: corrals & correlm LLP Law Penner 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission, See above 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: Somerset Hight School, Somerset, MA Yes High School College; George Washington University, Washington, DC Yes B,A, Other Secondary: Vlllanova University School of law, Villenova, PA Yes J,D„ I.L.M. (Tax) 14. Please list any professional affiliations (Optional): American Bar Association; Bnslol County Bar Association; erlstol County Estate Planning Council; Collier County Ser Ararx, allon; Hands Ber Assoclatlon; Fall River Bar Assoclatlon; Harvard Law School Federal Tax Clinic Pro Bono Panel; Mansfield Rotary Club; Massachusells bar Association; National Academy of Elder Law Allomeys; Newport County Bar Association; Norfolk and Plymouth Estate and Business Planning Council; Burns Island Bar Association; Rhode Island Bar Association Bar Journal Editorial Board; Rhode Island Bar Assoclatlon Annual Meeting Planning Committee 15, Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpful while reviewing your application. None. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest" provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. gnature Revised 3/21/13 per BSO Vote or3/20/13 CORREIRA & CORREIRA LLP . ATTORNBYs & COUNSELORS AT LAW 127 Dorrance Street Providence, R102903 401.454.5040 1415 Panther Lane Naples, FL 34109 239,649.5040 20 Park Plaza Boston, MA 02116 617.723,5040 20 Cabot Boulevard Mansfield, MA 02048 508.991,5040 1010 OAR Highway Swansea, MA 02777 508.679.5040 January 8, 2020 Mansfield Town Cleric 6 Park Row Town Hall, Second Floor Mansfield, MA 02048 Re; Application for Zoning Board of Appeals Dear Cleric Enclosed please find my application for the vacant seat on the Mansfield Zoning Board of Appeals. If you have any questions, please do not hesitate to contact me. Very truly yours, CORREIRA & CORREIRA LLP By; ric D. Correira, Esq. Enclosures Name: Mark cnrsillo 1804 West St. Telephone No. (Home) E-Mail Address: Town of Mansfield Application to Serve on a Board, Conupission, - - 5 Committee or Study Group " Dateilaoa020 617-997-8329 Are you a registered voter in Mansfield? Yes x No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. Planning Board B. Zoning Board of Appeals 3. Why do you want to serve on this particular Board, Committee, or Commission? I am interested In the Planning or Zoning boards because I'd like to be involved in the future development of Mansfield. I've had an Interest In these fields since playing SlmCity as a teenager and would like to be a pan of the teal -world implementation, and conversations with Steve Schoouveld and Olivier Kozlowski have piqued my interest in these two Boards, specifically. 4. Fresh Please state three attributes you can bring to this Board, Committee, or Commission. I'm lived in Mansfield for 3 and a half years. Independent - no conflu3s of interest, financially or personally. Perspective - as a young, single, childless mmmute, in Mansfield, I'd bring a unique sat of perspectives to the Board. 1 u 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) I have attended a few meetings of the Planning Board, 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? No immediate changes. 7. What is your availability? Nights? Weekends? Full availability on nights and weekends. 8. Do you regularly attend Town Meeting? Yes x No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield'? Yes No x 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A, B, 11. Please list your present employer Dates: Dates: (Optional) Employer: Position: Waytair - Senior Engineer, IT Security 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. I hold an expired real estate sales license, and as such have a mon..hal better-than-..mge understanding of real estate law, and have done a fair amount of reading of Mansfield's by-laws. 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: Regis High School, N. York NY Yes College: Northeastern University, Boston MA Yes Other Secondary 14. Please list any professional affiliations (Optional) nla 15. Please list any other specialized interests and hobbies (Optional): Technology, automation 16. Please provide any additional information you feel may be helpful while reviewing your application. I have been involved in town civics in an all capacity as a poll worker for the 2020 Election under Marianne Staples, wonting with Steve Schoonveld, and in an unoffical rapacity as a former administrator for the 'Everything Mansfield' unofficial town Facabook group, working with former Select Board and planning/zoning board member Olivier Kozlowski. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest" provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. lgnature Revised 3121/13 per BSO Vote of 3/20/13 3 a Town of Mansfield Application to Serve on a Board, Commission, Committee or Study Group Name: C 11ee4 e- ey-54L1r, Date // // Lzb Addrncc• 6 an/bj C4 Telephone No. (Home) 5d ? o�G (" p 8 °7� (Cell) 66 S 5P5 - ;26ro E-Mail Address: e. q(ASge e ?a Contac2S�.r� � 1. Are you a registered voter in Mansfield? Yes No _ Town Boards, Commissions, Committees: Airport Commission Historical Commission Animal Welfare Committee Industrial Development Commission Board of Assessors Library Trustees J Cable Access Board of Directors Municipal Building Committee Conservation Commission Planning Board Council on Aging Recreation Commission -1 ✓Cultural Council WWII Scholarship Fund Committee f Finance Committee Zoning Board of Appeals Board I�ealth Keep Mansfield Beautiful Committee � ` ' ✓ Othe J B ua A n iY4ts� 2. Please mark your two choices in order of preference: A. l,Ul�u(al (,aw✓tGi B. 6),(Ift 4664SS ^6L CreA¢ (Aaw) 3. Why do you want to serve on this particular Board, Committee, or Commission? 4. Please state three attributes you can bring to this Board, Committee, or Commission. d✓[aA��ieC� &mod ��el c3— SkofSR _ qfe jjrjS1L(P T�"� 1 Oyt(4, , 13. Education Background: Name and Location High School: n t,t&k % College: bi0 JPGI aW (0(6 t Other Secondary: C 14. Please list any professional affiliations (Optional): Graduated (Yes or No) Pa /,0 Jvl n (w r15iel)to, �-/ YI>Mcj 7. r'wure0 suy. ..,el/el5.q L4,kq/ ". 15. Pleaselistany other specialized interests and hobbies (Optional): i Degree(s) j�•%'�Q3ufihei5 h�nQ✓rG(_ c /e.S 1� 93 16. Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest" provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Signature Revised 3/21/13 per BSO Vote of 3/20/13 Town of Mansfield ICE Application to Serve on a Board, Commission, 2 Committee or Study Group L J Name: l,hdS4'L Aaw bcm Date 2010 Address: ZI KIoqm� Telephone No. (R) %. Pell- �q, 2q3. 2731 E-Mail Address: Cs ODI_ & "o e (C),y) I. Are you a registered voter in Mansfield? �I } Town Boards, Commissions, Committees: Airport Commission Historical Commission Animal Welfare Committee Industrial Development Commission Board of Assessors Library Trustees Cable Access Board of Directors Municipal Building Committee Conservation Commission Pl_a_nnin B Council on Aging Recreation Ca mois;i@ b Cultural Council c o�ars in Fun Committee Finance Committee Zoning Board of Appeals Board of Health Keep Mansfield Beautiful Committee Other: 2. Please mark your two choices in order of preference: A. B . 3. Why do you want to serve on this particular Board, Committee, or Commission? Nl. Inc lq�f 5uirS 4. Please state three attributes you can bring to this Board, Committee, or Commission. 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) ar4'&o h�r�►h�( Bari/�i�. m��(�n� u��er �Cmmis3��n 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? � 0 Iv 7. What is your availability? Nights? Weekends? 8. Do you regularly attend Town Meeting? Yes V No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. Dates: B. Dates: 11. Please list your present employer: (Optional) Employer: Position: p', 1 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. 13. Education Background: Name and Location Graduated Degree(s) j� (Yes or No) G High School: nch Sr hc,(( College: ��rk K l sc hdvt n bdscn) )992 Other Secondary: 14. Please list any professional affiliations (Optional): 15. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest" provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Signature Revised 03/21/13 Per BSO Vote of 03/20/13 a Town of Mansfield Application to Serve on a Board, Commission, iCt Committee or Study Group Name: ff)?�Il, I 01 //�I 5c b Date Address: / / 6WA rlgck& Telephone No. (Home) (Cell) & 5) Sol 6 - / / / E-Mail Address: / to as h/ L7 4 o !d L U m I . Are you a registered voter in Mansfield? Yes —v<' No Town Boards, Commissions, Committees: Airport Commission Historical Commission Animal Welfare Committee Industrial Development Commission Board of Assessors Library Trustees Cable Access Board of Directors Municipal Building Committee Conservation Commission Planning Board Council on Aging Recreation Commission Cultural Council WWII Scholarship Fund Committee Finance Committee Zoning Board of Appeals Board of Health Keep Mansfield Beautiful Committee Other: ©NeN 5P/3Ce d- ,ECRfA1lUAl Comm-r-Te'r 2. Please mark your two choices in order of preference: A. OHA� 5AWCC040CRY.4UDN' B. 3. Why do you want to serve on this particular Board, i or Commission? Please state three attributes you can bringtothis Board, Committee, or Commission. 0na d-l�.�e pe"OA,f rL- n of .I^ 30 veows of lao si NSe R.AlA ,a RC ct l ESA a /4-i esd .c h e ✓e l v g Pp-. 0& edacaj,'o ✓Idyl b4tCkj, YD6[h KjOc t lire Pared me 7,L,,, � twor-'< {{,,j anal t re,42ae l y at Any �icsK Zhr�tclrrj Kc- M, S. Have you attended any meetings of this Board, Committee, or Commission? (Optional) YeS- V oft, plese4l d a incmber. 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? Xg-f 41 f4L } 24"e 7. What is your availability? Nights? Weekends? Al2j4t5. ewe- 4V owt® CV/S/3 8. Do you regularly attend Town Meeting? Yes No -11 is Yu. k- 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes tI", No 10. If you answered "yes" above, please list the Boards, Corunittees, and/or Commissions you have served on: A. (le" SV«e 0Re1ie4Ak1 6mi%?`► e Dates: o s- l K 4-o prejeA If. Please list your present employer: (Optional) Dates: Position: ,tea%)nk 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. 13. Education Background: Name and Location Graduated Degree(s) III jy� g r (Yes or No) ( L J �( j� High School: /lciyie'riak �/d'�ri 172f� S��y0( l es 5j IU%oftGY,4,,7 /1 U6/ K1e S¢ w/o�o i M 4 g {� Q /t) �q �} College: BLbW A 1 YI ltl et-.$ l N KfS B r A a,t cji,17 6/vngI ge�kk)w 1A'Ad jf keA Other Secondary: 9 wm %10 2ilerl" I / e S A ! I . '' o" erl? N ijo n (c 1 &)s tl d /! S 15. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Signature Revised 3/21/13 per BSO Vote of 3/20/13 Town of Mansfield 1 C E aApplication to Serve on a Board, Commission, , FD ;: 1,0Q /- / Committee or Study/Group �q Name: / r 1 i C, .�f lqaye % /'"-C L 7 � II )Date Address:( 6 S/ E)n .,S f hq<61'e Ib1, ''%1A ;} f�.o,4 Telephone No. (Home) / (Cell) / % 2 9 )3 6 L E-Mail Address: Ali kc-@Al(�)Prop .l...U/l 1. Are you a registered voter in Mansfield? Yes ✓ No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: HIstorical Commission Industrial Development Coininission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board orAppeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. 136q111 B 3. . Why do you want to serve on this Board, Committee, or Commission? 4. Please state three attributes you can bring to this Board, Committee, or Commission. W wJ! ... Or'r, (rjj1Jw4,)C)$ :'nj vl(J.=e I,J ✓ld �I::fq�%'e t� >or vvc� il.K'Veld.? T!-Au^P/.'J, Irk4 (:{hnjCl Oa ,Ssves e.i)1,e( dj"'h 0� tt�der >41` Gil�P��✓c.� 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? 7. What is your availability? Nights? Weekends? qu' J h r'la f � f�f ( (!n Dina W<, 6A A i C nteeLlR�. 8. Do you regularly attend Town Meeting? Yes ✓- No 9. Have you ever served on a Board, Committee, or Commissioq in the Town of Mansfield? Yes No to, If you answered "yes" above, please list the Boards, Cotmnittees, and/or Commissions you have (� served on: A. Dates: cl U)3 1��e zt1'� B. (,� Dates: iUl3- vr? dYil'-d.c��ea 11, Please list your present employer: (Optional) 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. o,,^Slit. l eNPia.at/ tlp��insa }i,,.- dot�n , SJTe a 10ej1-A Z h"a i, n ,nnd (dvlA k< A„✓ o�l,c� al�✓tIli" i �JC.�I! Vhe enn✓yti (/11 SF; <ld ,� Sd;.,y i4� haU�� t'j,"o .11.E 5,/cydl,r, 13. Education Background: Name and Location Graduated Degrees) (Yes or No) High School: College: 0rry -5 k /"S R(A(i,i(o(iJ %i�L'f;c.�i SG/e:nre. Other Secondary: 14. Please list any professional affiliations (Optional): 15. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional infora ation you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest" provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Signature Revised 3/21/13 per BSO Vote of3PO/13 Town of Mansfield - I is i, L c Application to Serve on a Board, Commission, Committee or Study Group �,__ Name: Michael Flaherty Date November 19, 2020 Address: 39 Willow Street, Mansfield, MA 02048 Telephone No. (Home) (401) 219-0297 E-Mail Address: mike.aaherty@marshmma.com (Cell) (401)219-0297 Are you a registered voter in Mansfield? Yes x No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2, Please mark your two choices in order of preference: A, Finance Committee M 3. Why do you want to serve on this particular Board, Committee, or Commission? My (amity and I moved to Mansfield from Norton in June of this year. While In Norton, I served as a member of the Board of Selectman and spent nearly a decade on the_Flnance Committee prior_I feel that my prior experience would be additive 4. Please state three attributes you can bring to this Board, Committee, or Commission. Experience, Open-mindedness, Reliability _- 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) I have not as of yet 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? I am not aware of any at this time 7. What is your availability? Nights? Weekends? I am available as needed 8. Do you regularly attend Town Meeting? Yes X No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes No X 10, If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. Dates: B. Dates: 11. Please list your present employer: (Optional) Employer: Position: Marsh & McLennan Agency • New England President of Business Insurance 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. Nearly 15 years of experience In municipal governance between FlnCom and Board of Selectmen In Norton, MA 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: Bishop Henddcken High School Warwick, RI Yes Diploma College: University of Rhode Island Yes BA, Marine Affairs Other Secondary: 14. Please list any professional affiliations (Optional): 15. Please list any other specialized interests and hobbies (Optional): 16, Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appo abide by the provisions of the statute, Revised 3/21/13 per BSO Vote of320/13 QeEelne/ i K,e Town of Mansfield -0�f A9 AO10�A Application to Serve on a Board, Commission, C, � ICE Committee or Study Group, (: i Name: Keats Frenaae, MPH Date November 3,2020 - J Address: 12 South While Pine Lane, Mansfield, MA 02048 Telephone No. (Home) 7/a719-2735 E-Mail Address: kaala.freneae02Q9mall.wen (Cell) 203-2735a84 Are you a registered voter in Mansfield? Yes x No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. Bcardof Heats 3. Why do you want to serve on this particular Board, Committee, or Commission? I have been a member of The Board of Health for the past 3 years. I have enjoyed working with the other board members as well as the health agent. We have updated and implemented new regulations to improve the public health of Mansfield. I would like to continue to help Improve the slato of public health in our town. 4. Please state three attributes you can bring to this Board, Committee, or Commission, optimistic Fair and Honest Adeptible 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) Yes, I attend monthly meetings 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? I would like to continue to update and implement regulations as needed 7. What is your availability? Nights? Weekends? Nights. Weekends with notice. 8. Do you regularly attend Town Meeting? Yes x No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes x No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. Board of Health it. Please list your present employer: (Optional) Employer: Position: Unemployed Dates: January 2018-present Dates: 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. KNOWLEDGE SKILLS Epidemiology- Infectious Diseases Disease Outbreak Investigation Community Health Education Disease Somalia. Diabetes Prevention Contact Tmcingllnvestigation 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: Enrico Femd High School Enfield, CT 06082 YES YES College: SoumemcrstateunNemlty New Haven, CT YES Bachelor of Sclence-Public Health Other Secondary: Southern CT State university New Haven, CT YES Master of Public Health 14. Please list any professional affiliations (Optional): Former member of certified Health Education Specialist (CHES) 15. Please list any other specialized interests and hobbies (Optional): Health and Wellness Biebeles Prevention Community Education Nutrition 16. Please provide any additional information you feel may be helpful while reviewing your application. I have rely enjoyed being a member of the Board of Health and I hope to continue. I believe our board has made major improvements in Mansfield and given the oppurtunity we can continua to enhace our towns public health infrastructure. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. 1 Signature Revised 3/21/13 per BSO Vote of 3/20/13 Kasia A. Frenette, MPH 12 South White Pine Lane, Mansfield, MA02048 Email: kasia.frenette02C@email.com Skills 10 years of public health experience at the state and local level Infectious disease management and surveillance Extensive interview skills, contact tracing, directly observed therapy for Tuberculosis Outbreak experience Data analysis and management Team liaison Self -Motivated Experience YMCA DIABETES PREVENTION PROGRAM LIFESTYLE COACH HOCKOMOCK AREA -YMCA Cell: 203-273-5884 2017 - present • Provides support and guidance to participants in the YMCA Diabetes Prevention Program. • Implements standard curriculum designed for the program. • Facilitates group discussions and motivation through open-ended questions, support and encouragement. • Record weekly data for each participant (attendance, body weight, physical activity). YMCA HEALTHY HEART AMBASSADOR HOCKOMOCK AREA -YMCA 2020 • Completed the YMCA Healthy Heart Ambassador Training. • Recruited individuals to enroll in the YMCAs Self Monitoring Blood Pressure Screening Program. • Educated individuals as to the proper techniques to self -monitor blood pressure and the benefits of self monitoring. YMCA NUTRITION DETECTIVE HOCKOMOCK AREA -YMCA 2018-2019 • Educated third grade students how to be a "nutrition detective" focusing on five clues for better nutrition. A program developed by Drs. Katz and Katz. 1/3 FIELD EPIDEMIOLOGIST, EPIDEMIOLOGYAND EMERGING INFECTIONS PROGRAM STATE OF CT DEPARTMENT OF PUBLIC HEALTH, HARTFORD, CT 2002.2006 • Responsible for disease surveillance, investigation, analysis and dissemination of data. • Implemented disease surveillance for smallpox and anthrax post 9/11 to identify a possible bio-terrorist attack. • Developed and implemented standardized infectious disease follow-up for local health departments. • Collaborated with personnel from local health departments, hospitals, laboratories, long-term care facilities and educational organizations. • Assisted with outbreak investigations. • Provided local health departments with supervision and on -site assistance during investigation of any acute disease outbreaks. CASE MANAGER/EPIDEMIOLOGISTTUBERCULOSIS (TB) PROGRAM, STATE OF CT DEPARTMENT OF PUBLIC HEALTH, HARTFORD, CT 1999-2002 • Responsible for monitoring all aspects of TB cases in Western CT. • Performed Directly Observed Therapy for TB patients, which is the standard of care as recommended by CDC. • Identified close contacts of active TB patients and referred for evaluation and treatment as needed. • Collected data to perform routine statistical calculations, analysis and interpretation of tuberculosis data using MS Access and Epi Info. • Developed and maintained a surveillance database using MS Access to track and trace the Restriction Fragment Length Polymorphism (RFLP) types of TB cases to analyze and identify common risk factors and disease patterns. PREVENTION COORDINATOR TB PROGRAM STATE OF CT DEPARTMENT OF PUBLIC HEALTH, HARTFORD, CT 19974999 • Managed the daily operation of the TB Registry Management Systems Database including troubleshooting, creating daily queries, tables & reports for management staff. • Established positive rapport with other health care professionals to aid in public health issues. • Delegated tasks to colleagues in other departmental divisions in order to ensure State Laws and Policies were implemented. • Contacted local health departments, physicians and health care providers to discuss patients' treatment. 2/3 Education Master's Degree of Public Health, 2005 Southern Connecticut State University, New Haven, CT Bachelors of Science, Public Health,1996 Southern Connecticut State University, New Haven Professional Publications and Presentations Elizabeth M. Begier, Kasia Frenette, Nancy L. Barrett, Pat Mshar, Susan Petit, Dave Boxrud, Kellie Watkins -Colwell, Sheila Wheeler, Elizabeth A. Cebelinski, Anita lennen, Dao Nguyen, James L. Hadler, and The Connecticut Bioterrorism Field Epidemiology Response Team A High -Morbidity Outbreak of Methicillin-Resistant Staphylococcus aureus among Players on a College Football Team, Facilitated by Cosmetic Body Shaving and Turf Burns. Clinical Infectious Diseases 2004; 39(10):1446-1453. Elizabeth M. Begier, M. Steven Oberste, Marie L. Landry, Timothy Brennan, Diana Mlynarski, Patricia A. Mshar, Kasia Frenette, Terry Rabatsky-Ehr, Katherine Purviance, Ava Nepaul, W. Allan Nix,Mark A. Pallansch, David Ferguson, Matt L. Cartter, and James L. Hadler An Outbreak of Concurrent Echovirus 30 and Coxsackievirus Al Infections Associated with Sea Swimming among a Group of Travelers to Mexico. Clinical Infectious Diseases 2008:47(5): 616-623. International Conference on Emerging and Infectious Diseases, 2004 Enhanced Surveillance for Smallpox using a Chickenpox Surveillance System 3/3 Town of Mansfield RLCEIVED rt r IRV) OFFICE Application to Serve on a Board, Commission, ` Committee or Study Group 2020 JUN 19 A & 23 Name: Sharon Friedman Address: 29 Pleasant Street, Mansfield, MA 02048 Telephone No. (Home) 508-208-6618 E-Mail Address: sfriedman2931 "iAINt i IcLD Date dune 18,2020 M Sc,,; 1NUcFjjS (Cell) 509-208-6818 1. Are you a registered voter in Mansfield? Yes x No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. Planning Board - unexpired term B. 3. Why do you want to serve on this particular Board, Committee, or Commission? I am currently serving on the Planning Board as an Alternate member. I would like to continue to serve on the Board as a full member to complete the vacated term. Coincidentially, the vacated term expires at the same time as my current term as the Alternate, which is December 31, 2023. 4. Please state three attributes you can bring to this Board, Committee, or Commission. J. Experience of serving on the Board as an Alternate Member since 7.14.2016 2. Knowledge of Mansfield's Zoning By -Laws and building codes 3. Ability to work collaboratively with members and other Boards and committees 4. Knowledge of systems and process which aid in decision -making 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) Yes. Attend and participate on a regular basis; currently, as an Alternate member 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? 1. Maintain balance of growth as the Town continues to develop; 2. Continue to be mindful of the needs of the Town for growth especially in the TOD and Industrial/Commercial areas versus the needs in other sectors such as affordable housing; and 3.Support the Implementation of the newly minted Master Plan; 4. Support the development of the Cultural District designation; and 6. encourage community participation in the planning process. 7. What is your availability? Nights? Weekends? Able to attend meetings at night and at other times as needed. 8. Do you regularly attend Town Meeting? Yes x No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes x No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. Currently on Planning Board Dates: 7.14.2016 - Present B. Currently on Open Space and Recreation committee Dates: 2018 - Present 11. Please list your present employer: (Optional) Employer: Position: Retired 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. 1. Knowledge of building codes as ADA regulations 2. Strategic planning skills; have written strategic plans for non-profit organizations 3. Ability to review data and ask relevant questions 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: Dighton -Rehoboth Regional High School, Dighton, MA Yes Diploma College: Boston University, Boston, MA Yes BS(1970) M.Ed.(1978) Other Secondary: 14. Please list any professional affiliations (Optional): Red Cross - 2009-Present- Disaster Mental Health Team member; Integrated Care and Condolence Team member MAAssociation of Licensed Mental Health Counselors YMCA Alumni - Association for YMCA retired professionals 15. Please list any other specialized interests and hobbies (Optional): Interest in adults and children with special needs 16. Please provide any additional information you feel may be helpful while reviewing your application. Other town involvement: 1. Serve on the Cultural Council since November 2018 2. Serve on the Board of the Natural Resources Trust of Plainville 3. represent the Planning Board on the Capital Improvement Projects committee I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Cleric, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Sharon Friedman '�='?;=�,=-••-••--•-- Signature Revised 3/21/13 per BSO Vote of 3/20/13 r o Town of Mansfield DI C E q DABA ,4,, Application to Serve on a Board, Commiss'o Committee or Study Group _n3 A k 5U Name:��/C/lv4E�// Date Address: Telephone No. (Home) -5-ag-?Y%�,vrPS (Cell) 7Ty-1�71-dKIb 16 E-Mail Address: Xlll1elUe— kL9/zA,1 AEi 1. Are you a registered voter in Mansfield? Yes G' No �etivab�osrds,�Coxirntissiensr�omm3ttss&•- Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Tivance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Lotinig7Board of Appeafs Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. fft)/V B /VrY.f/ 3_ Wkv do yen want to serve on this particular Board, Committee_ or Commission? E(/��{�/R�b JG/i �✓i of ,/ /c- v ' aSO�"A- 4. Please state three attributes you can bring to this Board, Committee, or Commission. S. Have you attended any meetings of this Board, Committee, or Commission? (Optional) 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? Fri �� G� /t /. ell �i�1701/'-' - � n -,F curd/.r �H, � n rI" .d✓� cF' F/r.�L� „�..u. r�9%' lise � err 7. What 'isLyour availability? Nights? Weekends? �rf4 8. Do you regularly attend Town Meeting? Yes �No 9. Have you ever served on a Board, Committee, or Commission in thgTown of Mansfield? Yes _� No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served/on: A.Dates: F�/G%C B. �CYLI G Dates: X,;;t a!' /v ✓,—�f_ 11. Please list your present employer: -fir' Employer: Position: 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. 13. Education Background: Name and Location Graduated Degree(s) (Ye r N.Q , High School: _T 4/�t 72i d ✓ "t-u < 7�sOQ s6z ors I College: / wiw� c ems. � Grp Other Secondary: 14. Please list any professional affiliations (Optional): .5; Pleaw list any afihc�spe iulized-intereaf and habbie - tiomr}� 16. Please provide any additional information you feel may be helpful while reviewing your applieatiam. v- cJe,11V 11Ce -I wil'i-read-a-copy rrf h 3tfassachusettsvetxeral Laws Ckapter 26BA "Corrfliieh of Interest" provided by the Town Cleric, if appointed, and to the best of my ability agree to abide by the provisions of the statute. .zq Signature Revised 3/21/13 per BSO Vote of 3/20/13 Town of Mansfield `? EI C0`4E©Y f SCE O Application to Serve on a Board, Commis A ` , P 3: 50 Committee or Study GrouVLO ,,, Name:. D. Austin Horowitz 539 North Main Street Telephone No. (Home) E-Mail Address: dahorowilz@gmaii.com Are you a registered voter in Mansfield? Yes Date 3131/20101 (Cell) 508-203-1203 Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A SRPEDD Commissioner B, Registrar of Voters 3. Why do you want to serve on this particular Board, Committee, or Commission? I would enjoy the opportunity to continua to offer my skills and knowledge to support the Town of Mansfield and Its residents by continuing to represent our interests on the SRPEDD Commission, ensuring that Mansfield continues to be well represented in the planning and economic development activities that SRPEDD conducts. Also, I am currently serving as an officer of the Commission, finishing up a one year term as treasurer. 4. Please state three attributes you can bring to this Board, Committee, or Commission. 1)1 have a legal background (JD, Columbia University; voluntary inactive member of the California Slate Bar), which allows me to be comfortable with the many federal and state laws, miss, and regulations that surround the varied activities of SRPEDD. 2)1 have an educational background In transportation planning, having conducted by graduate thesis research under Fred Salvucci, former Secretary of Transportation for the Commonwealth. 3) 1 am always looking for ways to make our town, community, and region a better and even more successful place to live and work, Have you attended any meetings of this Board, Committee, or Commission? (Optional) Yes; I am the current Board of Selectmen appointee to the SRPEDD Commission, and have attended nearly all of the previous year's meetings (as recorded In the publicly available meeting minutes). I am also currently serving as the chair of the SRPEDD Commission's Finance Committee as I am serving as Treasurer of the organization. 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? I would continue to encourage the Town to utilize SRPEDD's resources to the fullest extent, including the Municipal Assistance hours that are granted as part of our per capital SRPEDD levy. Also, the rate to utilize SRPEDD's planning staff is significantly lower than any private finn, and given that SRPEDD Is an agency of the Commonwealth under M.G.L. c.30B, §1(b)(9) any contract with SRPEDD Is not subject to Chapter 308 7. What is your availability? Nights? Weekends? I am generally available evenings; In particular, the Commission tends to meet the evening of the fourth Wednesday of the month. I am also available to attend Finance Committee meetings which are generally held once a month, first thing In the morning. I am also available to attend occasional Select Board meetings to provide updates and solicit feedback, as appropriate. 8. Do you regularly attend Town Meeting? Yes x No Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes x No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. Board of Registrars of Voters Dates: 2013-Present B. SRPEDD Commission Dates: 2014-Present 11. Please list your present employer: (Optional) Employer: Position: ICF (Cambridge, MA) Principal, Aviation Consultant 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. As mentioned elsewhere, I have both a law degree as well as a graduate level degree in transportation planning (M.S.T, Massachusetts Institute of Technology). Therefore, I feel that I have a broad knowledge of both the legal realm as well as in transportation and urbaMand planning efforts, which provides an excellent foundation for my Involvement with the Commission. D 13. Education Background: Name and Location High School: East Brunswick High School, East Brunswick, NJ College: Rutgers University, New Brunswick, NJ Other Secondary: Columbia University School of Law, New York, NY 14. Please list any professional affiliations (Optional): Graduated Degree(s) (Yes or No) Yes Diploma Yes B.S.I.E., B.A. Yes is. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpful while reviewing your application. As disclosed each year, I do not believe that the SRPEDD appointment disqualifies me from serving on the Board of Registrars of Voters under MGL c. 51, sec. 25; however, I would continue to encourage the Town to seek affirmation from Town Counsel of this point. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. 0UA Signature Town of Mansfield Application to Serve on a Board, Commission !I Committee or Study Group =ij"I - 3 ?Q: Name: Julie Jonas Address: 484 Williams St. Telephone No. (Home) me E-Mail Address: julie.f.n.jones®gmmI.com tl (3 1110212020 (Cell) (508) 631-0823 1. Are you a registered voter in Mansfield? Yes X No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. Industrial a Development Commission B. 3. Why do you want to serve on this particular Board, Committee, or Commission? As a member of the IDc for the past three years, it has been exciting to see the advances made toward Mansfield's economic growth. I would like to continue to be a pad of the committee and see through the existing projects as well as take on new ones. 4. Please state three attributes you can bring to this Board, Committee, or Commission. Willingness to put in work toward achieving goals Enthusiastic toward growth In the Town of Mansfield and excited to see that happen Experience as an IDC member and ability to build on this existing knowledge 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) Yes 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? With new members and the pandemic, we have struggled to keep a normal meeting schedule. Hopefully going forward we will be able to get back on track with meetings. 7. What is your availability? Nights? Weekends? Weeknights and some weekends 8. Do you regularly attend Town Meeting? Yes x No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes x No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. Industrial& Development Commission Dates: 01/01118-present B. Dates it. Please list your present employer (Optional) Employer: Position: Boston Health Care for the Homeless Program Director of Patient Finance 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. 9 years of professional management experience in the non-profit sector with a focus on public health, ability to innovate and put new ideas into action a 13. Education Background Name and Location Graduated Degree(s) (Yes or No) High School: King Philip Regional High School, Wrentham, MA Yes H.S. Diploma College: Sacred Heart University, Fairfield. CT Yes Bachelors of Science- Sociology Other Secondary: Suffolk University, Boston, MA Yes Masters of Public Adminletragun 14. Please list any professional affiliations (Optional): 15. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Revised 3/21/13 per BSO Vote of3/20/13 Julie Jones Signature Town of Mansfield KUr.IVED S OFFICE Application to Serve on a Board, C0mmi#8J0'EC 23 A D 21 Committee or Study Group P Name: l_.bt4,(.S Kiy)r, Date _� `ZCi T (� , Address: ly ,<'�i^f2 �.i t il��✓T7�� (� C�'f�� Telephone No. (Home) (Cell) 50S - �941 5 -A 21 �O r-Mad Address: ('94+i y k1 Y7GR l`_'.` 2 e� 75 0.6 "'y able-eT CLi"7 (U)JIM Are you a registered voter in Mansfield? Yes i✓ No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals ( o Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A.1CQI�o i'Yllttl-4." 60V (, A I B. 4. Please state three attributes you can bring to this Board, Committee, or Commission. i'}1A4 (Yt tt-` Ir2rYtCb; Ii4" 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? F�4.I�h rnn(v- ,oclv,(A mq4ja,C�itici h�c�f71� t�,ho C,ortz 7. What is your availability? Nights? Weekends? 8. ➢o you regularly attend Town Meeting? Yes No ✓ 9. Have you ever served on a Board, Conunittee, or Commission in the Town of Mansfield? Yes No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. III 11. Please list your present employer: (Optional) Dates: Dates: 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. l� u 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: F�-ulef�.� GP�twr7/ l� �4ecit College: O{' err rn 6� IL Other Secondary: ✓✓ 14. Please list apy p ..�ofessional affiliations (Optional): •- 15. Please list any other specialized interests and hobbies (Optional): v 16. Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Revised 3/21/13 per BSO Vote of 3/20/13 Signature o ser Town of Mansfield tO S OFF ICE Application to Serve on a Board, Com isAOR Committee or Study Group n (C3 I_` Name: Carol Kosel Date 10128/2020 Address: 64 Monahan Lane, Mansfield MA 02048 Telephone No. (Home) 508-261-0257 E-Mail Address: cakosel@comcast.net (Cell) 508-561-1185 1. Are you a registered voter in Mansfield? Yes x No Town Boards, Commissions, Committees: Airport Commission Historical Commission Animal Welfare Committee Industrial Development Commission Board of Assessors Library Trustees Cable Access Board of Directors Municipal Building Committee Conservation Commission Planning Board Council on Aging Recreation Commission Cultural Council WWII Scholarship Fund Committee Finance Committee Zoning Board of Appeals Board of Health Keep Mansfield Beautiful Committee Other: 2. Please mark your two choices in order of preference: A. Animal Welfare Committee B. 3. Why do you want to serve on this particular Board, Committee, or Commission? I have been a member of the Committee for several Years and feel I bring the necessary skills to be useful to the Committeerrown. 4. Please state three attributes you can bring to this Board, Committee, or Commission. In my professional life I have been fortunate enough to learn several skills that I believe are helpful to the Committee. These include an ability to seek clarity and consensus in a professional and cooperative manner, to organize and prioritize goals, and to communicate effectively to other Committee members and volunteers. Have you attended any meetings of this Board, Committee, or Commission? (Optional) I have attended all but a handful of the Animal Welfare Committee meetings since 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? I would continue to work with the ACO and other Committee members to enhance the policies and procedures of the Shelter to provide the highest quality of care for our resident animals, to provide guidance for our volunteers to help them achieve our standards of care and to keep themselves safe from harm, and to strengthen our adoption process to achieve even higher success rates than we currently have. 7. What is your availability? Nights? Weekends? I am available as needed as my current job is primarily work from home. 8. Do you regularly attend Town Meeting? Yes x No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes x No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. Animal Welfare Committee Dates: 2012-2020 B. Dates: 11. Please list your present employer: (Optional) Employer: Position: self-employed Independent board member of Nationwide Mutual funds 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: Bismarck High School, Bismarck No Yes HS Diploma College: University of Minnesota, Moorhead, Moorhead, MN Yes BS Accounting Other Secondary: 14. Please list any professional affiliations (Optional): 15. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest" provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Carol Kosel Signature Revised 3/21/13 per BSO Vote of 3/20/13 Town of Mansfield Application to Serve on a Board, Commission, Committee or Study Group Name: Meahew List Address: 19 Liberty at Telephone No. (Home) E-Mail Address: malt llst@gmail.wm November 10, 2020 (Cell) 617-935-9057 1. Are you a registered voter in Mansfield? Yes x No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWil Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. Zoning Board of Appeals B. Finance Commiaee 3. Why do you want to serve on this particular Board, Committee, or Commission? 1 have served as an alternate on the ZBA since February 2020 (tailing were term due to exyire at We end Office year),I enjoy reviewing the details of applications end applying the town'$ zoning bylaws. Serving on the zoning boom because it requires detailed measure into each lot, the town's by-laws. and other precedents in the state. I would also be interested In the finance commiaee If any vacandes are ever available because I believe my experience as an economist could be valuable to the board. 4. Please state three attributes you can bring to this Board, Committee, or Commission. 1. Experience - during my tenure on the board as an alternate this year. I have been appointed to vote in several matters, Including both residential nnA commercial nnnli—finrtc 2. Impartiality - the Zoning Board makes tough dedsicns that directly affed residents, so impar0ality is important. 3. Familiarity with the intent of the town'$ zoning bylaws, which I've become more familiar with through the master planning steering committee. 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) Yes, I attended all 2020 meetings, and prior to my appointment I reviewed several prior meetings on the cable acmes websita to familiarize myself with the board. 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? No. 7. What is your availability? Nights? Weekends? I am available most weeknight evenings and weekends. 8. Do you regularly attend Town Meeting? Yes X No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes x No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. Zoning Board of Appeals (alternate member) Dates: Curmntiy (since Feb. 2020) B. Master Plan steering Committee 11. Please list your present employer: (Optional) Employer: Position: ... ....................... Economist Dates: 2049-2020 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. mrience in economics would be useful on the board. Much of my work involves providing economic analysis in litigation matters, so ona fP A-nawsed Is 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: Taylor High school, Katy, TX, Diploma (2001) College: Boston College. Chestnut Hill, MA. BA In Economics, Minor in math (2005) Other Secondary: 14. Please list any professional affiliations (Optional): American Economic Association Amadcan Ber Associaton, Antltrust Section 15. Please list any other specialized interests and hobbies (Optional): History. I was previously a volunteer for Boston By Foot, providing walking more in Boston that focused on the city�s architecture and history 16, Please provide any additional information you feel may be helpful while reviewing your application. 1 have lived in Mansfield since October 2009 I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Signature Revised 3/21/13 per BSO Vote of 3/20/13 Town of Mansfield fprt; +RECEIVED ERM'S OFFICE Application to Serve on a Board, CommissIM AN _8 p b: 39 Committee or Study Group Name: MatlnewLial Date January B, 2020 Address: 19 Liberty St Telephone No. (Home) (Cell) Biz-gas-gosr E-Mail Address: 2. A. Are you a registered voter in Mansfield? Yes X No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee Please mark your two choices in order of preference: Board of Appeals B. Finance Commitlee 3. Why do you want to serve on this particular Board, Committee, or Commission? I would like to be more involved in the town, and through the master planning steering committee I have become more Interested in how the town's zoning ordinances affect the town. The zoning board of appeals Interests me because it is designed to be an impartial body that balances the town's zoning ordinances with the practical limitations of inegularly shaped lots, pre-existing structures and other unique circumstances. I would also be interested in the finance committee if any vacancies are ever available because I believe my experience as an economist could be valuable to the board. 4. Please state three attributes you can bring to this Board, Committee, or Commission. 1. Impartiality - the Zoning Board makes tough decisions that directly affect residents, so impartiality is important. 2. Familiarly with the town's zoning areas, which I've become more familiar with through the master planning staining committee. f 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) I have watched many of the zoning board meetings on the Mansfield cable access website. Since finding out about the zoning board vacancy, I have been reviewing minutes of previous meetings on the town website. 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? No. 7. What is your availability? Nights? Weekends? I am available most weeknight evenings and weekends. 8. Do you regularly attend Town Meeting? Yes X No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes X No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. Master Plan Steering Committee Dates: Currently (since 2019) B. Dates: it. Please list your present employer: (Optional) Employer: Position: Charles River Associates Economist 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. I believe my experience In economics would be useful on the board. Much of my work involves providing economic analysis in litigation matters, so remaining Impartial and fact-locused is Imported. 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: Taylor High School, Katy, Tx, Diploma (2001) College: Boston College, Chestnut Hill, MA. BA in Economics, Minor in math (2005) Other Secondary: 14. Please list any professional affiliations (Optional) American Economic Association American Bar Association, Antitrust Section 15. Please list any other specialized interests and hobbies (Optional): History. I was previously a volunteer for Boston By Fool, providing walking tour: in Boston that focused on the city's architecture and history 16. Please provide any additional information you feel may be helpful while reviewing your application. I have lived in Mansfield since October 2009 I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Signature Revised 3/21/13 per BSO Vote of 3/20/13 Eq Not )l Town of Mansfield ,w. o i ICE ASA Application to Serve on a Board, Commission, Committee or Study Group 3 ! Name: Jean Mallon Date October 27, 2020' Address: 7 Darby Drive, Mansfield Telephone No. (florae) None (Cell) 617-908-6567 E-Mail Address: Mailonj@verizon.netorjmallon@mansfieldma.com 1. Are you a registered voter in Mansfield? Yes X No RECEIVED C 2D2� Town Boards, Commissions, Committees: TOWN OF MANSFIELD BOARD OF SELECTMEN S OFFICE Airport Commission Historical Commission Animal Welfare Committee industrial Development Commission Board of Assessors Library Trustees Cable Access Board of Directors Municipal Building Committee Conservation Commission Planning Board Council on Aging Recreation Commission Cultural Council WWII Scholarship Fund Committee Finance Committee Zoning Board of Appeals "Board of Health Keep Mansfield Beautiful Committee Other: 2. Please mark your two choices in order of preference: A. Library Trustees B. Cultural Council 3. Why do you want to serve on this particular Board, Committee, or Commission? I would like to serve another term as a Library Trustee so we can continue the work we are doing providing Library services to our patrons. - 4. Please state three attributes you can bring to this Board, Committee, or Commission. The three attributes I can bring to the library Trustees are my administrative experience, my work ethic, and my commitment to public Service. 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: Malden High School, Malden, Mass. H. S. Diploma, 1968 College: Boston University, B. S. Education, 1972, Villanova University, M.A. Education, 1976 Other Secondary: Providence College, M.Ed. Counseling Education, 2004 14. Please list any professional affiliations (Optional): 15. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpful while reviewing your application. I was not able to correct the capital letters at the beginning of the second line on this document. Sorry. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Signature Revised 3/21/13 per BSO Vote of 3/20/13 a,P41NPl , i � p 1•eaA9AV�54 Name: Ryan Maxwell Address: 149 PArk STreet Telephone No. (Home) Town of Mansfield Application to Serve on a Board, Commission, Committee or Study Group E-Mail Address: Ryan.M.Maxwanogmall.coin Date 11/2/20 (Cell) (509)e44-9617 1. Are you a registered voter in Mansfield? Yes X No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. Board of Health 3. Why do you want to serve on this particular Board, Committee, or Commission? I want to be Involved and help out in town and the applications that the Board of Health review are of particular Interest to me. 4. Please state three attributes you can bring to this Board, Committee, or Commission. I am fair, honest and consistent. ;ilCEt 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) I have not attended any meetings on the Mansfield Board of Health, but have attended Board of Health meetings In other towns and other local board/commillse meetings. 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? No changes. 7. What is your availability? Nights? Weekends? Weekday nights. 8. Do you regularly attend Town Meeting? Yes x No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes x No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. Conservation Commission Dates: Oct 2013 - Dec 2017 B. Zoning Board of Appeals Dates: Jan2ole-current 11. Please list your present employer: (Optional) Employer: Position: Bracken Engineering, Inc. Project Engineer 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. I am a Title 5 system inspector and design septic systems for work. I have an in depth understanding of Title 5, the Wetlands Protection Act, The Massachusetts Slonnwaler Regulallons and well requirements. u 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: Mansfield High School Yea College: Wentworth Institute ofrechnology Other Secondary: 14. Please list any professional affiliations (Optional): Yes BS - 15. Please list any other specialized interests and hobbies (Optional): I enjoy the outdoors, playing with my 3 kids and working on my house, 16. Please provide any additional information you feel may be helpful while reviewing your application. I feel like my professional background makes me an excellent candidate for the Board of Health. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Revised 3/21/13 per BSO Vote of 3120/13 Ryan Maxwell"'°;,;.„w',,.,,,.;,a, Signature "QG\N01 ray Town of Mansfield .-IC $M"`° r•e°'` Application to Serve on a Board, Commis$io>}„ I: Qu Committee or Study Group Name: Micas) McCarthy pate Novembe, 2020 Address: 19 Monahan Lane, Mansfield MA Telephone No. (Home) 50e-339-0050 (Cell) 774-266-0117 E-Mail Address: mlkermcc@holmail.com Are you a registered voter in Mansfield? Yes x No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. Keep Mansfield Beautiful Committee B. 3. Why do you want to serve on this particular Board, Committee, or Commission? I would Ilk. to continue working towards achieving the mission of the committee, making Mansfield a cleaner and greener community. 4. Please state three attributes you can bring to this Board, Committee, or Commission. Organizational skills (leadership, team building) Financial (serving as treasurer for the committee) 5. Have you attended any meetings of this Board, Committee, of, Commission? (Optional) Yes, as a member of the committee since Its Inception. 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? 7. What is your availability? Nights? Weekends? Both 8. Do you regularly attend Town Meeting? Yes x No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes x No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A, Keep Mansfield Beautiful Dates: Inception to present B. Dates: H. Please list your present employer: (Optional) Employer: Position: 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: Somers High School, Somers New York Yes College: Rensselaer Polytechnic Institute Yes BS Computer Science Other Secondary 14. Please list any professional affiliations (Optional): 15, Please list any other specialized interests and hobbies (Optional): 16, Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Michael McCarthy Signature Revised 3/21/13 per BSO Vote of 3/20/13 Town of Mansfield Application to Serve on a Board, Commission,' t 1S OFFICE Committee or Study Group iQu21 �,ijL 10 A & 24 Name: Abrahim Mercill ( Preferred Name: Abraham Mercy) Date 07/09/2020 i M1 r Address: 38Fairfield ParkMansfield MA02048 Telephone No. (Home) 302 289 6786 (Cell) 786 584 2773 E-Mail Address: abrmercv(a)outlook.com I. Are you a registered voter in Mansfield? Yes, e!!"*No Town Boards, Commissions, Committees: ,/Airport Commission Historical Commission Animal Welfare Committee Industrial Development Commission Board of Assessors Library Trustees Cable Access Board of Directors Municipal Building Committee Conservation Commission Planning Board Council on Aging Recreation Commission 1,/Cultural Council WWII Scholarship Fund Committee Finance Committee Zoning Board of Appeals Board of Health Keep Mansfield Beautiful Committee Other: 2. Please mark your two choices in order of preference: A. Cultural Council B. Airport Commission 3. Why do you want to serve on this particular Board, Committee, or Commission? 1 believe in serving,serving both my family and my c untry Family starts from Your home and cotuary starts 4. Please state three attributes you can bring to this Board, Committee, or Commission, )Ur LIQ i S 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) Yes 1 attended the first meeting of the Cultural Council on July 711 2020 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? Not immediately. but overtime I would like. to learn understand and share my lhoughts with the comtninec Myfirst goal is managing our mescal situation. undcrstondin our ur challengcg, and searchingfor rnew Es to achieve our mission 7. What is your availability? Nights? Weekends? I can be available at any timebased on need and planning. 8. Do you regularly attend Town Meeting? Yes No E /* 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes No _Aef-" 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on; A. Dates: B. Dates: 11, Please list your present employer: (Optional) Employer: Position; Delta Proiects`Inc. (DDS Agency) Director of IT 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. o Information Technology and Security o Team and Event Management o Training Management ` 13. Education Background: Name and Location High School: St. Joseph's High School, India College: National College, India. Graduated (Yes or No) Yes Degree(s) Yes Bachelors in Computer Science. Other Secondary: 14. Please list any professional affiliations (Optional): Diploma in Computer Science Certification in Quality Management from Phil Crosby Institute 15. Please list any other specialized interests and hobbies (Optional): • Technology • Aviation Technology and Procedures • Security Systems • Volunteering, • Biking • Music • Cultures 16. Please provide any additional information you feel may be helpful while reviewing your application, • Member of Patient Family Advisory Council at Dana Farber Cancer Institute since 2017 • Volunteer at Boston Children's Hospital since 2017 I will read a copy of the Massachusetts: General Laws Chapter 268A "Conflict of Interest" provided by the Town Clcrk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Signature Revised 3/21/13 per BSO Vote of 3120/13 C%Her A Town of Mansfield C ICE a A�lAaAeA �6fT Application to Serve on a Board, Commission,,,, 0 ur Committee or Study Group 0 Name: Kris Mousseae Date duly 15, 2020 Address' 15 Martha's Way, Mansfield, MA 02048 Telephone No. (Home) 508-261-7224 (Cell) 508-284-7740 E-Mail Address' kmoussette@hinckleyallen.cum 1. Are you a registered voter in Mansfield? Yes X No Town Boards, Commissions, Committees: Airport Commission Historical Commission Animal Welfare Committee Industrial Development Commission Board of Assessors Library Trustees Cable Access Board of Directors Municipal Building Committee Conservation Commission Planning Board Council on Aging Recreation Commission Cultural Council WWII Scholarship Fund Committee Finance Committee Zoning Board of Appeals Board of Health Keep Mansfield Beautiful Committee Other: Auditcommittee 2. Please mark your two choices in order of preference: A. Audit Committee B. 3. Why do you want to serve on this particular Board, Committee, or Commission? My term on the Audit Committee expired on June 30, 2020. [would like to be reconsidered for another tens so that I can continue to serve the town and the community '.. in which I live. '.. 4. Please state three attributes you can bring to this Board, Committee, or Commission. I am a public finance attorney and am knowledgeable about municpal finance. 1 am also familiar with town approval process. Being a municipa '.. finance lawyer, I can help spot Issues and answer questions for the town. 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) Yes, current term expired June 30,200 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? Not at the present time. 9. What is your availability? Nights? Weekends? Days and nights. Weekends not preferred but would be available. 8. Do you regularly attend Town Meeting? Yes x No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes x No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. Audit Committee Dates: B. Dates: 11. Please list your present employer: (Optional) Employer: Position: Hinckley, Allen a Snyder LLP -Attorney (Partner) 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. 1 have nearly 25 years expedence in municipal finance from a legal perspective, I am familar with reading financial statements and the Issues that towns like Mansfield face. f 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: Holy Name CCHS, Worcester, MA - Yes - High School Diploma College: Colby College, Waterville, ME - Yes -B.A. Other Secondary: Boston College Law School, Newton, MA -Yes -J.D. 14. Please list any professional affiliations (Optional): various legal trade groups, including National Association of Bond Lawyers 15. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpful while reviewing your application. I would be pleased to assist the town that I love] I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Moussette, Kris A Signature Revised 3/21/13 per BSO Vote of 3/20/13 v EcxOp o Town of Mansfield - s -iCL 9AADA8AS,p4 Application to Serve on a Board, Commissign,,.I Committee or Study Group Name: 7I4-a��'L U Na.w Telephone No. (Home) JAG 3 3 q I$ 0 Date )1 118% 2a 7 c n r-� 'I-1y 2(niv 30V E-Mail Address: iSc, (��1 fSL.0 COMCC(5t, Re+ (Cell) 1. Are you a registered voter in Mansfield? Yes V No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. IOUnCII OF) in B. .J 3/ Why do you want to serve on this particular Board Committee, or Commission? �I n a>r,,Cl'= hlar0- 6,34 7-4.. ta'44 m<Y 'In eflu ctle i J o r G, a5 CGrn chow CC ee � t S G aal I SQ O jjjq1 n t enet s 2 curse raget r t� ?0e( Icg Cr�MMY dtu till wuuldu(I�cr+ rr a ice C" ma,nct it hove �Yhe ia�srel� G)t's yhi5�'ot�. 4. Please state three. attribut s you can bring to this Board, Committee, or Co mission. En` l,wosm. (4V 1>\IOt`ktRQ Wti'� 0u` i Uht S nlcrs� Of1Lj (plpM1M1CdA s Its C u, cra��re. ,m- c(12r>- �dnrac�ol� � WA urn�te k Z have ex 'ens rss�sh Q*(s carA q1hlwlr' nereg�r s clpve( 1w, Skci i S4i�rzu�l,-`ke uV (Cmm�eat rCucc��sw �emcuti t [M'8 Lwoncepe � and F( as ssibte, , 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? 7. What is your availability? Nights? Weekends? 8. 9. 10. A. B. Do you regularly attend Town Meeting? Yes No �Ix Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes No _1,,� If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: It. Please list your present employer: (Optional) 12: Dates: Dates: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. 1 rnri,�iinh^rmsra r-YM (c _4,n4d 6atiA //AG6h6i arij bj_ Cm I lu l rL vass Vead C4 Cttn U5 ��V�A l'�k COMMUM6 V1wy gams Wck- as j-Iea( cap P�/J, Wcu'ver, hake beets a prrknfr ct a� Mari mh�q'i�e ffeml4-k_%Ca 2 Sysle.l� aS 0.aqLvef- �.t�en 2aL COMM" 5comps av -Fall P&1 ("ll I a cetcp School as t:,j of I,. 5u,1a, J 13. Education Background: High School: P Y College: Other Secondary: Name and Location ,bk tt4,h 1 14. Please list any professional affiliations (Optional): Graduated Degree(s) (Yes or No) } WK2cissiu1, LU)ad(s &&f 15. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Revised 3/21/13 per BSO Vote of 3/20/13 ' Signature sovWx a. o Town of Mansfield Application to Serve on a Board, Commission,,-�� Committee or Study Group Name: Ana Newer Date1012312020. r_U Addrpcc' 15 Echo Hills Drive Mansfield, MA 02046 Telephone No. (Home) E-Mail Address: anagardenlady@co mm.net (Cell) 508-523-1246 1. Are you a registered voter in Mansfield? Yes x No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. Keep Mansfieid aeau0ful Comm0tee B. 3. Why do you want to serve on this particular Board, Committee, or Commission? I am a current member of the Committee and would Ilke to cun@nca to serve our community. 4. Please state three attributes you can bring to this Board, Committee, or Commission. Extensive knowledge of plant:. Nees and shrubs Project Management Organimflonal skills 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) Yes, I am a current committee member, 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? Confirms m Beautify Mansfield 7. What is your availability? Nights? Weekends? Al 8. Do you regularly attend Town Meeting? Yes No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes . No 10. if you answered `yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. Keep Mansfield eeauliful Dates: Current B. Dates: 11. Please list your present employer: (Optional) Employer: Position: ji:L� rm elt� 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: / J CJNB 9)a.rn¢, Q h 5C Jg0 D (, y t°S College: r,covcaLne-e C 011-eye, Nag 13A Other Secondary: 14. Please list any professional affiliations (Optional): 15. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpfiil while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest" provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. l� Signature Revised 3/21/13 per BSO Vote of 3/20/13 Town of Mansfield Application to Serve on a Board, Commission, Committee or Study Group REC"IVED CLFRKS OFFICE Z029 JAN I U A lD. 53 r",P;NSF1EL0 Y' ��� Name: Y y j�1 1(� i �« L 1ln Date Address: S 01A _BY I f 1 rd j Telephone No. (H) J -'I (i dLo to 1 J�1 (w) E-Mail Address: 1. Are you a registered voter in Mansfield? U' Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical _Co o duitt_d! Development Commission 'L'ib�ary Ties ees' __Snt C Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A.B. 3. Why do you want to serve on this particular Board, Committee, or Commission? 4. Please state three attributes you can bring to this Board, Committee, or Commission. 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) --nb� Ij_ A f ttniyii I VA 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? 7. What is your availability? fights eekends? 8. Do you regularly attend Town Meeting? Yes V No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: G] 1.3 11. Please list your present employer: (Optional) Employer: Position: Dates: Dates: 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. k, 13. Education Background: Name and Location G duated Degree(s) Ye or No) High School: College: Other Secondary: 14. Please list any professional affiliations (Optional): 15. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest" provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. �)/P^ �igAature Revised 03/21/13 Per BSO Vote of 03/20/13 Town of Mansfield rED " Application to Serve on a Board, Commission OFFICE Committee or Study Group tr;l0 U _9 A 10: 00 Name: Melanie 12 Newton Street, Mansfield Telephone No. (Home) (sn) 949-668a E-Mail Address: melanlel.omalley@gmail.com IVki f;J 4'; Date7/812020 (Cell) same as home Are you a registered voter in Mansfield? Yes X No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. Cultural Council 0 3. Why do you want to serve on this particular Board, Committee, or Commission? I am a lover of the arts. I appreciate everything from murals and art installations in public parks to theater, dance, and music, I believe that arts It is very important to 4. Please state three attributes you can bring to this Board, Committee, or Commission. 1. Strong leadership ability, especially in helping volunteer groups grow and thrive 2. Collaborative work style with a focus on supporting the team as a whole 3. Passion for everything from the nuts and bolts to laying out an overarching vision and values statement of a committee 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) Yes, I attended the July 2020 meeting 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? I have served on fully volunteer run boards and committees and understand the challenges that they face in terms of fulfilling duties while simultaneously optimizing operations. If appointed, I would like to help the Cultural Council improve its communications and organizational systems. 7. What is your availability? Nights? Weekends? Currently, I have open availability. I will continue to have night and weekend availability should my daytime availability change, 8. Do you regularly attend Town Meeting? Yes No X Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes No X 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. 123 Dates: Dates: it. Please list your present employer: (Optional) Employer: Position: Most recent: Massachusetts Public Health Association, Communications and Policy Manager 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. Communications skills including: press releases, membership emails, website design and maintenance, and social media Experience volunteering with fully volunteer run non -profits including serving as President of the Boston Chapter of NOW 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: Weymouth High School, Yes College: University of Massachusetts, Boston, Yes, B.A in Women's Studies Other Secondary: University of Massachusetts, Boston, Yes, Graduate Certificate in Women, Politics, and Public 14. Please list any professional affiliations (Optional): 15. Please list any other specialized interests and hobbies (Optional): I enjoy reading, running, and photography. I am an animal lover and care deeply about animal welfare. I also love nature and enjoy the outdoors. I am passionate about equal access to resources, including to the arts, for people of diverse backgrounds and ability. 16. Please provide any additional information you feel may be helpful while reviewing your application. I have more than ten years' experience working with volunteer boards and committees as well as working for nonprofit organizations, including a state commission. I am looking for an opportunity to serve my community and know I would be a good fir for the MLCC. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Signature Revised 3/21/13 per BSO Vote of 3/20/13 tC o µo Town of Mansfield ri 1 o I 1L F_ Application to Serve on a Board, Commission, r 7-11 Committee or Study Group A Name: `h4t��Gg 1c f iUCCt Date''��O�Aq� i Address: C S Sell l e4 MGIi P:e l d, MA 010 `+ f Telephone No. (Home) S CJ 3 3 J 4 S%% (Cell) Soy —'I 6 1` Ll H a E-Mail Address: 7 77G i 1. Are you a registered voter in Mansfield? Yes No Town Boards, Commissions, Committees: Airport Commission Historical Commission Animal Welfare Committee Industrial Development Commission Board of Assessors Library Trustees Cable Access Board of Directors Municipal Building Committee Conservation Commission Planning Board Council on Aging Recreation Commission Cultural Council WWII Scholarship Fund Committee Finance Committee Zoning Board of Appeals Board of Health Keep Mansfield Beautiful Committee Other: 2. Please mark your two choices in order of preference: A. Ca1cQt20i st;onB. C01iwrA1 COUr7ej 3. Why do you want to §erve on this particular Board, Committee, or Commission? intorrck¢Ai11SvP,,:n i; IA,-1,.^,io✓i�� i , X., i g �tod�' Eo(Yllt'1�1n��.CaiS iv('qkaf'siN�, 4. Please state three attributes you can bring to this Board, Committee, or Commission. �I.. a 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? 7. What is your availability? Nights? Weekends? 8. Do you regularly attend Town Meeting? Yes ✓ No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes No t/ 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. Dates: B. Dates: IL Please list your present employer: (Optional) Em loyer: Position: 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. 13. Education Background: High School: 0y College: 1r C e Name and Location Graduated nn (Yes or No) Degree(s) �Oa`� �ai��, C-mot 4h'Ol1 Other Secondary: 14. Please list any professional affiliations (Optional): 15. Please list any other specialized interests and hobbies (Optional): a --am S�� ct#l;� UAL 0�.rl� 16. Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest" provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. r gnature i Revised 3/21/13 per BSO Vote of3/20/13 Name: Darlene Pruitt 1VED Town of Mansfield �E ElCE Application to Serve on a Board Zt6m6ii)siAt,9: 35 Committee or Study Group �tQ i I i Date 10/28/2020 18 Pleasant Street #4 Telephone No. (Home) E-Mail Address: dpruitt@mansfieldma.com (Cell) 617-417-0973 Are you a registered voter in Mansfield? Yes X No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. Zoning Board of Appeals B. 3. Why do you want to serve on this particular Board, Committee, or Commission? I am a current voting member of the Zoning Board of Appeals and the clerk of the board. I am seeking reappointment. I would like to continue to serve the Town of Mansfield and its residents by upholding and applying the zoning laws of the town. 4. Please state three attributes you can bring to this Board, Committee, or Commission. I believe my experience as a board member since 2013 and clerk of the board for two plus years contributes to my ability to review applications and apply the zoning laws as they were intended. My educational background has provided me with the tools to analyze the law, rules and regulations of the State and the town. 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? The Town of Mansfield continues to grow and with the growth comes the need for change. There are several residential development projects and a new restaurant which is attracting more people to consider Mansfield as their home. Setbacks should be reviewed for residentail, industrial and business zones. Signs for local businesses need more restrictions and enforcement. 7. What is your availability? Nights? Weekends? I am available nights and weekends. 8. Do you regularly attend Town Meeting? Yes No X 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes X No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. Zoning Board of Appeals Dates: Dates: 11. Please list your present employer: (Optional) Employer: Position: 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. Knowledgeable of Mansfield's zoning laws as a current board member since 2013 Educational background and ability to analyze and interpret the law. Employment experience in real estate transactions and disposal , 13, Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: Madison Park High School -Roxbury, MA Yes High School I College: Bunker Hill Community College -Charlestown, MA -Associates [)agree Suffolk University -Boston, MA- Bachelors [)agree Other Secondary: Curry College - Milton, MA - Master's 14, Please list any professional affiliations (Optional): 15, Please list any other specialized interests and hobbies (Optional): 16, Please provide any additional information you feel may be helpful while reviewing your application, I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. 7A� Signature Revised 3/21/13 per BSO Vote of 3/20/13 Town of Mansfield J rICE Application to Serve on a Board, Commission;". 53 Committee or Study Group LI i1U(� I t���r1112� �— Date I(' ad oZC) 2 Name: Address: IL(% 5UUl'J/}rnf4ilj 5I . #c??j} m/)Ns5FIed rnA Telephone No. (H) 4r/� 7 7 7 - 610 (W) E-Mail Address: Z'; Are you a registered voter in Mansfield? _Ye_5_ Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. CU1 TURa.L. C-0UnciL B. 3. Why do you want to serve on this particular Board, Committee, or Commission? I want to help support and promote the arts, humanities and social sciences in addition to cultural diversity in Mansfield, MA. 4. Please state three attributes you can bring to this Board, Committee, or Commission. 1. M_ y love for cultural diversity as a form of community love -- — As a teacher of ESOL (English to Speakers of Other Languages), my favorite aspect of my teaching experience is meeting different people from different cultures. Recognizing and embracing cultural diversity makes us compassionate towards others and removes negative connotations that past societies have used to discriminate community members. 2. My energy and interest for art and culture as a form of communication: I believe that art and culture Is a form of communication that can portray individual ideas and community ideas, which gives a voice to all community members. 3. My respect and belief for art and culture as a form of motivation and inspiration: I believe that diverse art can be a bridge connecting one culture to another culture to motivate and inspire community understanding. Have you attended any meetings of this Board, Committee, or Commission? (Optional) 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? N&- 7. What is your availability? Nights? Weekends? % OAdl P vl QQ- R i CVen ' h S 8. Do you regularly attend Town Meeting? Yes No x 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes _ No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A Dates: . B. Dates: 11. Please list your present employer: (Optional) Employer: _ Position: Bristol Community College — Teacher of ESOL (English to Speakers of Other Languages) for Adult students 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. - — Media __ a press. 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: tungwicK 1/2T2�linS Y>ley�OrZr0.� �_ttlf!(��i�%G _ i ��tli��(JYn� Teaching English as a Second Language .Coll,, 14. Please list any professional affiliations (Optional): 15. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpfid while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. 4 Signature Revised 03/21/13 Per BSO Vote of 03/20/13 C ICE, q A Tolm of Mansfield Application to'. Serve on a Board, Commission, Committee or Study Group Name: /1o. ('0 n R t3 - " 1 Address: 219 071-? `S S (— Telephone No, (Home) 77 % ?i 2 Z o (Cell) 7 V 2/ E-Mail Address: a ro 4-11 Q e7a 1' A ec.S f /7 4 si(✓ Are you a registered voter in Mansfield? Yes% No _ Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: LL �+ t A. C01) Se (�V�T I`o n l uAfi^ SS 1-n 3. Why do you want to serve on this particular Board, Committee, or Commission? A. Please state three attributes you can bring to this Board, Committee, or Commission.. Have you attended any meetings of this Board, Committee, or Commission? (Optional) /CS.. .L.- a n I cL c✓rr0�I MQ/MG-0— pn/� 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? 7. What isyour availability? Nights? Weekends? a,<�ra.0 /t� 8. Do you regularly attend Town Meeting? Yes No 9. Have you ever served on a Board, Committee, or Commis stp the Town of Mansfield? Yes No 10. if you answered "yes" above, please list the Boards, Committees. and/or Commissions you have served on; L A_ CU�SSTVc. Dates: B. C 2 tq I C Dates; it. Please list your present employer; (Optional) Employer:N q 1 + Position; or ems afn 12; Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission, M Education Background: /f Name and Location High Sebool. �%I � I2 ll0 0 # S College: Other Secondary: 14. Plcaso list any professional affiliations (Optional): Graduated (Yes or No) ye f Degree(s) A=s q 15. Please list any other specialized interests and hobbies (Options )' 16. Please provide any additional information you feel may be helpful while reviewing your application. 4C.0 I 4 C. 0 L'e/I�1 J ✓1 �l � ✓ ' / M P Jai MM '`�iCC_.Gt1,Ccv�;,# I-L— __LiJ� ' V f�i✓� I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest" provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. 662 Signature Revised U11113 per RSO Vote of 3=13 o Town of Mansfield Application to Serve on a Board, Com >! o A 11: 31 Committee or Study Group (�� Name: - cCA �e2n �P r1� '� t Date Aa,trpec. 121 Ik h rj, S4-, 9 ri i, n h a an U,A- o al tp7 Telephone No. (Home) E-Mail Address: (Cell) 6�RI qq-L 'd ZLO in Mansfield? Yes No 1/ Boards, Commissions, Committees: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals / Keep Mansfield Beautiful Committee in order of preference: A. M�nrn lA7ll�lt{s�„��,. B. 1(yvpMa .iN,PK(. LW C,&Inu.Ttu6 3. y Why do you want to serve on this particular Board, Committee, or Commission? Please state three attributes can bring to this Board, Committee, or Commission. 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) U 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? 7. What is your availability? Nights? Weekends? 8. Do you regularly attend Town Meeting? Yes No 9. Have you ever served on a Board, Committee, or Commission in the Town of field? Yes No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. E] 11. Please list your present employer: (Optional) Dates: Dates: 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. 13. Education Background: High School: College: Name and Location Graduated Degree(s) (Yes or No) JS Other Secondary: 14. Please list any professional affiliations (Optional): 15. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest" provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Signature Revised 3/21/13 per BSO Vote of 3/20/13 pEC\NCI' n O g 9jAeASAe\5`P Name: aosemadealmis Town of Mansfield Application to Serve on a Board, Commission, r 0` F SCE Committee or Study Groupl�7� _ f S g: W b 10af110 North Main at Mansfield MA 02048 Telephone No. (Home) E-Mail Address: simisrose@yahoo.com DateJuly 2, 2020T {M1 ..: (Cell) 774-273-3325 Are you a registered voter in Mansfield? Yes YY_ No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Non profit Gift Fund Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference A. B. 3. Why do you want to serve on this particular Board, Committee, or Commission? I failed to renew my membership at the end of 2019. 1 have been on the committee since Its' conception and would like to continue. 4. Please state three attributes you can bring to this Board, Committee, or Commission. Loyality Fair and, a good listener to other's points of view 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) Yes 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? No 7. What is your availability? Nights? Weekends? Nlghtes and weekends but we meet at night 8. Do you regularly attend Town Meeting? Yes No 9. Have you ever served on a Board, Committee, or Commis on m the Town of Mansfield? Yes No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. Non profit gift fond Dates: conception to 2019 B. SkalebaNAdhe. Dates:'+ 1 11. Please list your present employer: (Optional) Employer: Position: Hdientemrise Owner 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. Great note -taking, gent leadership f Ib 13. Education Background: Name and Location Graduated (Yes or No) High School: Caribou High School. Carbou ME yes Degree(s) Business College: Southern New Hampshire University yes Secondary Educallon/MGMT Other Secondary: 14. Please list any professional affiliations (Optional): MWOT MMAS _- 15. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpful while reviewing your application. Just put me back on please and thank you I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Revised 3/21/13 per BSO Vote of 3/20/13 Town of Mansfield li i fi�ation to Serve on a Board, Commission, 31 Committee or Study Group Name: )6 W \ Date t1 /' Telephone No. (Home) E-Mail Address: I. Are you a registered voter in Mansfield? (cell) —72 �— a - OL S(O Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission I WWII scholarship Fund ommittee zoning Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. VV WY-1- Jl'_;(NC-i (AV B. FLX A L(3vv' (t%eQ® 3. Why do you want to serve on this particular Board, Committee, or Commission? 4. Please state I attributes you can bring ^ to this Board, Committee, or Commission. \� lln 1 iUi n #n 0 i\ W9 A N 13. Education Background: Name and Location Graduated (Yes or No) High School: College: C))i�'CL 1'Qsince-u� Other Secondary: 14. Please list any professional affiliations (Optional): 15. Please list any other specialized interests and hobbies (Optional): Degree(s) S in �Wcd (,a,WL 16. Please provide any additional information you feel may be helpful while reviewing your application. 6t i, bee i n G {.n_ (a a ra OA d Cx)o(-)I( i-0 o rn -k-i M iC 11 I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest" provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. �IF--jernmilk E o Town of Mansfield , VFO r 'S OFFICE p''foxs�as'�p~ Application to Serve on a Board,. Commission, Committee or Study Group"ti^?"LO _ P �tLt7 .,. ft, r� Tp Name: Matthew Teixeira Date 07/06/2020 1SF k TS Address: 1 Cherry St, Mansfield, MA 0204E Telephone No. (Home) 774-392-1355 (Cell) 774-392-1355 E-Mail Address: tex.matthew@gmall.com Are you a registered voter in Mansfield? Yes x No Town Boards, Commissions, Committees: Airport Commission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: MFN Regional Wastewater District Board Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. MFN Regional Wastewater District Board B. 3. Why do you want to serve on this particular Board, Committee, or Commission? I am Interested in town operations and have an engineering interest in the water processing and Infrastructure aspects of the town 4. Please state three attributes you can bring to this Board, Committee, or Commission. Chemical / process engineering education and work experience Detail oriented Interest in operations and management of water process facility 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) Yes, I just completed a partial term on this Board. 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? No 7. What is your availability? Nights? Weekends? Weekday evenings, weekends 8. Do you regularly attend Town Meeting? Yes x No 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes x No M11 A. MFN H If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: egional Wastewater District Board Dates: 712e19-612020 Dates: It. Please list your present employer: (Optional) Employer: Position: Metalor Technologies USA Process Engineer 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. Chemical Process Engineering background 13. Education Background Name and Location Graduated Degree(s) (Yes or No) High School: Franklin High School, Franklin, MA Yes High School Diploma College: Northeastern University, Boston, MA Yes B.S. Chemical Engineering Other Secondary: 14. Please list any professional affiliations (Optional): 15. Please list any other specialized interests and hobbies (Optional): 16, Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Teixeira, Matthew o :"o'roao>'m,:'o°aidovw°6iw Signature Revised 3/21/13 per BSO Vote of 3/20/13 Town of Mansfield ) ' ' CE Application to Serve on a 136 rd '�b"'issIion,�53 Committee or Study Group Name: WILLIAM L. WALKER Address: 144 S. MAIN STREET Telephone No. (Home) 508 339 7900 E-Mail Address: BILLWALKER1139®13MAIL.COM Date OCTOBER 22, 2020 (Cell) PREFERRED (617)594-1210 Are you a registered voter in Mansfield? Yes X No Town Boards, Commissions, Committees: Atrport"ommission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. AIROIRT COMMISSION B. WWII SCHOLARSHIP COMMOTTEE 3. Why do you want to serve on this particular Board, Committee, or Commission? I HAVE SERVED ON THE AIRPORT COMMISSION FOR SEVEN OF THE LAST EIGHT YEARS AND ENJOY SHARING MY AVIATION EXPERIENCE WITH THE COMMISSION IN PLANNING AND IMPLIMENTING STRATEGIES FOR THE AIRPORTS FUTURE 4. Please state three attributes you can bring to this Board, Committee, or Commission. MORE THAN 30 YEARS EXIEROENCE IN CORPORATE MANAGEMENT I'VE BEEN ACTIVELY INVOLVED IN THE AVIATION COMMUNITY SINCE 1973 1 AM KEENLY AWARE OF THE FAA'NEXGEN' MODERIZATION PROGRAM AS IT PERTAINS TO GENERAL AVIATION r 13. Education Background: Name and Location Graduated (Yes or No) H18h School: %AVERIAN BROTHERS HIGH SCHOOL -WESTWOOD MASS College: Other Secondary: 14. Please list any professional affiliations (Optional): Degree(s) 15. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpful while reviewing your application. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Revised 3/21113 per BSO Vote of 3/20/13 Signature 6 CpGG NC ii'l Town of Mansfield Application to Serve on a Board, Commission, � ;OFFICE Committee or Study Group iO3 JUL I b ^A 8, 34 Name: Jeffrey Ward 63 Baybrook Fan Road - Mansfield, MA Telephone No. (Home) 508.261.1477 =1LD Date July 15, 2020 (Cell) 617,930.3812 E-Mail Address: iward1olmlimall.com 1. Are you a registered voter in Mansfield? Yes Y No Town Boards, Commissions, Committees: Airport Commission Historical Commission Animal Welfare Committee Industrial Development Commission Board of Assessors Library Trustees Cable Access Board of Directors Municipal Building Committee Conservation Commission Planning Board Council on Aging Recreation Commission Cultural Council WWII Scholarship Fund Committee Finance Committee Zoning Board of Appeals Board of Health Keep Mansfield Beautiful Committee Other: 2. Please mark your two choices in order of preference: A. Keep Mansfield Beautiful 10 3. Why do you want to serve on this particular Board, Committee, or Commission? I have been a proud Board member for Keep Mansfield Beautiful since 2015 and would like continue helping our community. 4. Please state three attributes you can bring to this Board, Committee, or Commission. Expertise: Precinct Leader for the Cleanup, managing Programs like Adopt -A -Street Man -Power: KMB is a hands-on organization and we need people who are ready to get dirty (le. flower barrels, cleanups, etc.) Passion: I live and Mansfield and love this town. We all want Mansfield to look the best It can be, 5. Have you attended any meetings of this Board, Committee, or Commission? (Optional) I have a very strong attendance record over the past 5+years. 6. Are there any changes you would like to make if you are appointed to this Board, Committee, or Commission? Continued improvement. I 7. What is your availability? Nights? Weekends? We typically meet on Tuesday nights once a month which works. Cleanups and other events tend to fall on the weekend. 8. Do you regularly attend Town Meeting? Yes No N 9. Have you ever served on a Board, Committee, or Commission in the Town of Mansfield? Yes Y No 10. If you answered "yes" above, please list the Boards, Committees, and/or Commissions you have served on: A. KMB Dates B. Dates: I I. Please list your present employer: (Optional) Employer: Position: Winbrook- SVP, Business Development 12: Please list any skills or specialized knowledge you can bring to this Board, Committee or Commission. s 13. Education Background: Name and Location Graduated (Yes or No) High School: Arlington Catholic High School - Yes College: Bridgewater State University - Yes Other Secondary: 14. Please list any professional affiliations (Optional): 15. Please list any other specialized interests and hobbies (Optional): Degree(s) 16. Please provide any additional information you feel may be helpful while reviewing your application. I am currently a KMB member. This is simply a re -application since my term had lapsed in 2019 and I was unaware. I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest" provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Revised 3/21/13 per BSO Vote of 3/20/13 Jeffrey Ward Signature xm a, Town of Mansfield E i'I E D e I ' ',K\S OFFICE Application to Serve on a Board p nissio�l Committee or Study Grr4 E ' 3 4l 1°I S(= IELrD7 1 �''r 'iUSETTS Name: Vivian Webster Date1/31/2020��-`���' �'a " Address: 23 High St Apt 4 Telephone No. (Home) (Cell) 508-933-1097 E-Mail Address: vee.webster yahoo com Are you a registered voter in Mansfield? Yes X No Town Boards, Commissions, Committees: Airport Cormnission Animal Welfare Committee Board of Assessors Cable Access Board of Directors Conservation Commission Council on Aging Cultural Council Finance Committee Board of Health Other: Historical Commission Industrial Development Commission Library Trustees Municipal Building Committee Planning Board Recreation Commission WWII Scholarship Fund Committee Zoning Board of Appeals Keep Mansfield Beautiful Committee 2. Please mark your two choices in order of preference: A. Cultural Council B 3. Why do you want to serve on this particular Board, Committee, or Commission? Being part of the Mansfield Cultural Council will make me more aware of whats going on in my community. Aside from my usual social group serving will grant me the benefit to meet new people as well as aive back to the community by providing my insight and unique expertise to programs that are 4. Please state three attributes you can bring to this Board, Committee, or Commission. Straightforward and impartial Supportive Stewardship I 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School: Newton North High School/ Diploma College: University of Phoenix/ Bachelors Other Secondary: 14. Please list any professional affiliations (Optional): 15. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpful while reviewing your application. I'm a creative and resourceful professional with a passion for community engagement I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest" provided by the Town Cleric, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Revised 3/21/13 per BSO Vote of 3/20/13 f V.nadby PDFriftl I 7Z 02/6/202 I Signature ti o Town of Mansfield ASLCC�N Application to Serve on a Board; Commission, f' l- ICE Committee or Study Group A C, It Name: i/� i�'�L Crn l/l' ' �%1 Date J� 2 0 % S,4wAt 1 CT Address: ^- Telephone No. (Home)/>]5Ue, 7 (.0U`7 (Celq E-Mail Address: 1. Are you a registered,voter in Mansfield? Yes No i Town Boards, Commissions, Committees: Airport Commission Historical Commission Animal Welfare Committee Industrial Development Commission Board of Assessors Library Trustees Cable Access Board of Directors Municipal Building Comnuttee Conservation Commission Planning Board Council on Aging Recreation Commission Cultural Council WWII Scholarship Fund Committee mane Committe Zoning Board of Appeals r o ealth Keep Mansfield Beautiful Committee Other: 2. Please mark your two choices in order of preference: A. VV`PV(1� CcOW(V-dCB. C Please state three attributes you can bring to this Board, Committee, or Commission L 11t^ _, „ 13. Education Background: Name and Location Graduated Degree(s) (Yes or No) High School College: UN Q 6k!t 1 ! (%r— 9L� V ,•� Other Secondary: CGM#WLC.SCwAC �_ &-aCLy ( �)S '°eapt(� 1 Please list an rofe si�onal affiliations (Optional): 11�Vl,Ttyal � �u/L \'3 fWL� 1vVlr iA.NYJ S%V S �/,�iMl Cs%� 15. Please list any other specialized interests and hobbies (Optional): 16. Please provide any additional information you feel may be helpful while reviewing your application I will read a copy of the Massachusetts General Laws Chapter 268A "Conflict of Interest' provided by the Town Clerk, if appointed, and to the best of my ability agree to abide by the provisions of the statute. Signature l///4/2 v Revised 3/21/13 per BSO Vote of 3/20/13