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Board Application Form

2. Select the Board, Commission, or Committee applying for*
   -- Select One --Select OneAssessment Review BoardBicycle & Pedestrian Advisory CommitteeCable TV CommitteeConservation CommissionDavis Fund CommitteeDowntown & Outer Pleasant St Plan CommitteeHousing AuthorityMarine Resource CommitteePersonnel BoardPlanning BoardRecreation CommissionRecycling & Sustainability CommitteeRivers & Coastal Waters CommissionSewer District Board of TrusteesTree CommitteeTrust Fund Advisory CommitteeVillage Review BoardWater District TrusteesZoning Board of AppealsOther

4. If Other, what committee OR if specific membership type
   Fill this in if the Committee you are applying for is not listed OR if the Committee you applied for has different membership types (e.i. Alternate, Full) type here

   Fill this in if the Committee you are applying for is not listed OR if the Committee you applied for has different membership types (e.i. Alternate, Full) type here

6. First Name

7. Last Name

9. Address1

11. Address2

13. City

14. State

15. Zip

17. Home Phone Number

19. Cell Phone Number

21. Work Phone Number

23. Occupation

25. Email Address

27. Are you currently serving on other Boards, Commissions, or Committees?

    1. Yes
    2. No

29. If yes, which

31. Have you served on a Board, Commission, or Committee before?

    1. Yes
    2. No

33. If yes, which

35. Please list civic organizations to which you belong

37. Note any prior experience knowledge, or abilities that you have which would contribute to the activities of the board/committee/commission:

39. Upload Resume (Optional)

41. 1. Do you have any questions about what the Board/Commission/Committee does or on its charge?

43. 2. Do you have any practical experience or formal education that would be relevant to the Board/Commission/Committee?

45. 3. Why would you like to be on the Board/Commission/Committee?

47. 4. Are you aware of the time involved and would you be able to attend most of the meetings?

49. 5. Do you have any conflict of interest that might involve either a direct financial gain or other gain?

51. 6. Do you have anything you would like to add

Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit Submit and Print

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