period ending on the date of the individual’s appointment, the individual has been continuously registered to vote with the same political party, or has not been registered to vote with any political party. (C) The individual submits to the nonpartisan agency established or designated by a State under section 514, at such time and in such form as the agency may require, an application for inclusion in the selection pool under this section, and includes with the application a written statement, with an attestation under penalty of perjury, containing the following information and assurances: (i) The full current name and any former names of, and the contact information for, the individual, including an electronic mail address, the address of the individual’s residence, mailing address, and telephone numbers. (ii) The individual’s race, ethnicity, gender, age, date of birth, and household income for the most recent taxable year. (iii) The political party with which the individual is affiliated, if any. (iv) The reason or reasons the individual desires to serve on the independent redistricting commission, the individual’s qualifications, and information relevant to the ability of the individual to be fair and impartial, including, but not limited to— (I) any involvement with, or financial support of, professional, social, political, religious, or community organizations or causes