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

    1. Old Fashioned Christmas Committee
    2. Plan Commission
    3. Police & Fire Commission
    4. Senior Center Board
    5. 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.
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