Closed Landfill Remediation Grant Program Advisory Committee Member Application

The Closed Landfill Remediation Grant Program provides grants to local governments to help local governments cover the costs of remediation efforts and the management of closed landfills that they own. The Closed Landfill Remediation Grant Program Advisory Committee is comprised of two members representing local governments, two members representing the Colorado Department of Public Health and Environment, and one member with technical expertise in closed landfill remediation who is not affiliated with a local government or with the Colorado Department of Public Health and Environment. The advisory committee advises the Colorado Department of Public Health and Environment on the issuance of grants to local governments.

Please see the Closed Landfill Remediation Grant Program webpage for information about the Advisory Committee, including bylaws, guidance, and previous committee meeting (opens in a new window).

Advisory Committee members are appointed by the department’s Solid and Hazardous Waste Commission and serve a term of three years.

Please complete the application below in its entirety and attach a current resume prior to submittal. If you have questions about this application, contact Taylor Pierce at taylor.pierce@state.co.us or call (303) 692-3394.

Contact information

First name

Last name

Present employer

Preferred phone

Preferred email address

Please confirm email

Preferred address

City

State

Zip

County

Education and general qualifications

College

College name

College location (City, state)

Diploma received

Major course of study

Graduate school

Graduate studies

Graduate college location

Graduate diploma received

Major course of graduate study

Trade/Technical/ Vocational/Military

Memberships in Organizations

Please provide the following for volunteer experience:

Organization names.
Offices held/duties performed.
Indicate whether past of present.

Volunteer activities

Please provide the following for volunteer experience:

Organization names.
Offices held/duties performed.
Indicate whether past of present.

References

Reference one

Reference #1 name

Reference #1 phone

Reference #1 email

Reference two

Reference #2 name

Reference #2 phone

Reference #2 email

Reference three

Reference #3 name

Reference #3 phone

Reference #3 email

Qualifying information

Please indicate the type of entity you would represent on the Advisory Committee:

Local government

Department

Closed landfill technical expert

The Advisory Committee will need to meet to discuss grant applications at least two times per year. Will you be able to meet at least on a semi-annual basis to discuss grant applications with the department and other committee members?

Yes

Why are you a good candidate for this position? What skills, experiences, knowledge do you possess that will help you be a successful member of the advisory committee? Specifically highlight your experience in local government, managing and/or remediating operating or closed landfills, reviewing technical documents for closed landfills, or experience implementing the Colorado solid waste regulations.

Please upload your resume

Verification and signature

I certify that the facts contained in this application are true and correct to the best of my knowledge. I authorize investigation of all statements contained herein and the references listed above to obtain any and all pertinent information personal or otherwise. I release all parties for all liability for any damage that may result from furnishing such information. I understand that the Colorado Open Records Act requires that certain information contained in this application be available for inspection upon request.

For the purposes of this form, the Colorado Department of Public Health and Environment accepts your typed name and date as an electronic signature equivalent to your valid signature on a paper copy of the form. As such, this electronically completed form subjects the signatory to the same responsibilities as a hand-signed form. Per Section 18-8-306, C.R.S., it is a felony to submit false information to a state official.

Signature

Date +