Boards and Commissions Application

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* 1. Board or Commission Applied For:

	Community Boards and Commissions	Internal Staff Boards
Boards and Commissions	Boards and Commissions Community Boards and Commissions menu	Boards and Commissions Internal Staff Boards menu

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* 2. Contact Information

Name

Home Phone

Work Phone

Preferred Contact Mailing Address

City

Zip Code

E-Mail Address

Home Mailing Address if Different

City

Zip Code

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* 3. Please indicate at which address you would prefer to receive Board/Commission correspondence:

	Yes	No
Home	Home Yes	Home No
Work	Work Yes	Work No
Calls to Work	Calls to Work Yes	Calls to Work No
Calls to Home	Calls to Home Yes	Calls to Home No
E-Mail	E-Mail Yes	E-Mail No

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* 4. Current Occupation

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* 5. Education

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* 6. Please Describe any relevant work and/or volunteer experience which would contribute to your service on this Board or Commission:

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* 7. Why are you interested in volunteering for this Board / Commission?

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* 8. What do you perceive its function to be?

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* 9. Do you serve on any other local Boards or Commissions? If so, please list.

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* 10. Might your present employment or any personal affiliation create a conflict of interest for you as a member of this Board / Commission? Please explain:

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* 11. Please type in your name as an electronic signature.

Name:

Date Signed: