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Series 801.4P - Application to Serve on Equity Advisory Council

Adopted: August 2020
Revised: October 2021

The information requested below is for the purpose of evaluating your application to serve on the District 196 Equity Advisory Council. You are not required to provide the requested information, however, your failure to do so may prevent the district from processing your application. The information will be available to District 196 staff members processing your application and assembling the advisory council. Some of the information may also constitute public data under the Minnesota Government Data Practices Act.

Name (please print)


Phone Email

Do you have children who graduated from District 196? □ Yes □ No

Do you have children currently enrolled in District 196? □ Yes □ No

If yes, what schools do they attend?

Stakeholder role for which you are applying, check one:

□ Parent/guardian of enrolled student(s); (list grade[s])

□ Community member at large (must be a resident)

□ High school student (list school)

□ Teacher (list level or special education)

□ DCUE Executive Board member

□ Cultural Family Advocate

□ Principal

□ Assistant Administrator


Briefly explain your thoughts about diversity, equity and inclusion in public education.

Why do you want to serve on the Equity Advisory Council?


Please submit this completed application to: 
Director of Equity and Inclusion
Independent School District 196, 3455 153rd St. West
Rosemount, MN 55068

Or submit via email to: