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2. Board/Committee/Commission on which your are interested in serving on:*
4. Name
5. Email Address
7. Address*
9. City*
10. State*
11. Zip Code*
12. Number of Years in County:*
14. Best Phone Number to reach you:*
15. Occupation:*
17. Background:*

    What particular background, training, experience, special skills, knowledge, or aptitude which you feel would be an asset to the board(s) for which you are applying.

19. Experience:*

    What other board experiences, volunteer activities, or special interests do you currently have?

21. Interest:*

    Why are you interested in serving?

23. Limitations:*

    What limitations, if any, would be placed on the time you would be available for meetings and other activities? 

25. Are you available for daytime meetings:*

    1. YES
    2. NO
26. Are you available for evening meetings:*

    1. YES
    2. NO
28. Issues and Concerns:*

    What problems, issues, or concerns do you see facing this particular board, commission, or committee, and how would you propose they be addressed?

30. Optional:

    Please provide any additional information you would like considered here. You may wish to include information regarding education, knowledge, employment, or other pertinent information.

32. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
34. Electronic Signature
Leave This Blank:


36. Submit Submit and Print

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