Jackson County is currently seeking applications for individuals to serve on its Board of Developmental Disability Services (EITAS).  Complete all fields in this online application and press "DONE" for your application to be processed.  Thank you.

What is your first name?

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* 1. What is your first name?

What is your last name?

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* 2. What is your last name?

What is your street address (include city, state & zip code)?

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* 3. What is your street address (include city, state & zip code)?

Home Phone Number:

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* 4. Home Phone Number:

Work Phone Number

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* 5. Work Phone Number

Cell Phone:

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* 6. Cell Phone:

E-mail Address

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* 7. E-mail Address

Briefly describe your current employment:

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* 8. Briefly describe your current employment:

Are you currently a resident of Jackson County?

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* 9. Are you currently a resident of Jackson County?

Are you paid current on all taxes, including Jackson County property taxes?

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* 10. Are you paid current on all taxes, including Jackson County property taxes?

Do you currently have any business dealings with Jackson County, its officers or employees, or are you likely to in the future?

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* 11. Do you currently have any business dealings with Jackson County, its officers or employees, or are you likely to in the future?

Are you related to a person with developmental disabilities?

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* 12. Are you related to a person with developmental disabilities?

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