Board Application

Board or Commission of Interest *

Name *

Address *

Phone Number *

Email *

Principal Occupation/Source of Income (choose one) *

List the name of each business or trust that is NOT the principal source of income in which you have a financial interest: *

List below the associations or institutions with which you are closely associated or serve as a director or officer: *

List below the skills or qualifications you could bring to this Board or Commission: *

Explain your special interest or reason for serving on this Board or Commission. *

Have you been a resident of the County for at least six months? * Yes
No

By signing this application and clicking submit, I declare that I understand that an appointment to a County Board or commission is a voluntary, appointed position to be confirmed by the County Commission. I further understand that this application is public information and that the merits of my appointment may be discussed at a public forum. In addition, my name may be published in a newspaper or other media outlet.

Signature (Please Type Your Name) *

Date *

* - denotes required field