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Board and Commission Application
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Click here to download the Financial Disclosure Form if necessary
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Denotes a required field
Name
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Address 1
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City
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State
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-- Select a State --
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Midway Islands
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP
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Zip
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Zip +4
Second portion of ZIP Code is optional.
Email
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Primary Phone
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Phone Area Code
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Phone 3
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Phone 4
ext
Extension
Secondary Phone
Phone Area Code
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Phone 3
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Phone 4
Gender
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Male
Female
Not Specified
Please Do Not Complete The Following Field
Race / Ethnicity
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American Indian and Alaska Native Alone
Asian Alone
Two or More Races
Hispanic or Latino
Black or African American Alone
White Alone
Not Specified
Age Range
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Less Than 20
20-34
35-49
50-64
65+
Not Specified
Financial Disclosure
do you have an interest in any businesses by reason of:
(a) You own all or part of the business.
(b) A member of your immediate family owns all or part of the business.
(c) You are employed by the above business on a full or part-time basis.
(d) A member of your immediate family is employed by the above business on a full or part-time basis.
(e) You or a member of your immediate family receives income from a business under circumstances other than those listed in paragraphs (a) to (d) above.
Do you have any financial disclosures?
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Yes
No
If yes, please list The name(s) of the business, type of interest, and self or family member
Company (Employer)
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Occupation
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Bio
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Boards/Commissions you are interested in applying for
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Affirmative Action Advisory Commission
Housing Commission
Citizen Advisory Committee
Riverfront Improvement Commission
Civil Rights Commission
Library Board of Trustees
Civil Service Commission
Parks & Recreation Advisory Board
Combined Construction Code Board of Appeals and Review
Plan & Zoning Commission
Design Review Board
Zoning Board of Adjustment
Historic Preservation Commission
Experience, Education which qualifies you for this board/commission
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What contributions can you make, or state the reason for applying
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Are you a robot?
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