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Board / Commission / Committee

2. Name

3. Email Address

5. Address

7. City

8. State

9. Zip Code

11. Best Contact Phone Number

12. Date of Birth:

14. Length of Residence in City **

    **not required for select boards/commissions

15. Occupation/Employer

19. Board, Commission or Committee

    I wish to be considered for appointment to the following Board, Commission, or Committee:

    1. Beautification Committee
    2. Board of Review
    3. Board of Appeals
    4. Board of Health
    5. Equity & Inclusion Commission
    6. Housing Authority

    1. Library Board
    2. Old Fashioned Christmas Committee
    3. Plan Commission
    4. Police & Fire Commission
    5. Senior Center Board
    6. Water/Wastewater Commission
21. A list of Commissions, Committees, and Boards with a brief description of responsibilities is available in the City Clerk's office.

    A list of Commissions, Committees, and Boards with a brief description of responsibilities is available in the City Clerk's office.

25. Community Service Experience

27. Organization

28. Dates Served

29. Position/Duties

31. Organization

32. Dates Served

33. Position/Duties

35. Organization

36. Dates Served

37. Position/Duties

41. Education

    Please list all relevant secondary and post-secondary education experience, including areas of study and degrees earned.

45. Recent Employment History

47. Employer

48. Dates

49. Position

51. Employer

52. Dates

53. Position

57. Other relevant experience or expertise:

61. Why are you seeking appointment to this Board / Commission?

Leave This Blank:


63. 1. Receive an email copy of this form.
64. Email address

    This field is not part of the form submission.

65. Submit

* indicates a required field