Board/Committees Application

Please fill out the form as best as you can. If you have no answer, please write "Not Applicable".

Home Address:
Location of Residence:
Business Location (if applicable):
Cell Phone:
Home Phone:
Work Phone:

Check below the Committees or Boards you are willing to serve on:
Economic Development Advisory Committee
Library Board
Planning and Zoning Board
Parks and Recreation Advisory Board
Police Pension Board
Tree and Beautification Advisory Committee


Training or experience related to activities of boards and committees to which appointment is sought:

Member of the following professional or business organizations:

Have you served on a Town board or committee in the past?Yes  No

If yes, name of committees/boards and dates:

Nationality (optional)

Have you ever been convicted of a felony? (optional) Yes  No

List three references that the Town may contact (excluding Town employees) - name, address and phone number:

Add any additional information or comments here:

I will attend meetings in accordance with the adopted policies of the Town. If at any time my business or professional interests conflict with interests of the board or committee, I will not participate in such deliberations of the board or committee.

Please note: You may be required to fill out a financial disclosure form.

By submitting this form I certify the information I provided is true and accurate to the best of my knowledge.

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