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Bellevue Essentials Application

Name:
Street Address:
City:
State:
Zip Code:
Day Phone:
Email address:

Are you a Bellevue resident? Yes No

 Optional:  
 Gender  
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 Neighorhood  
 I am requesting financial assistance  

Why are you seeking admission to this program?

How do you hope to use your expertise for the benefit of the community?

If admitted, I commit to attend a minimum of 80 percent of the scheduled sessions.

I accept (By selecting the "I accept" button, you are signing this application electronically.)


  
Contact Information

Neighborhood Outreach
450 110th Ave NE
PO Box 90012
Bellevue, WA 98009
Contact: Julie Ellenhorn
Phone: 425-452-5372
E-mail: jellenhorn@bellevuewa.gov