Board & Commission Application Form

Date: Name: Home Address: Home Phone: Employer: Occupation: E-mail: Work Phone: Cell Phone: Please select which Board/Committee/Commission you would like to apply for: Board/Committee/Commission Name Normal Frequency of Meetings Term 4 years 3 years 5 years 3 years 3 years 3 years 4 years 3 years 3 years 3 years 3 years 3 years Once a quarter As needed As needed As needed Once a month As needed Once a month Once a month Twice a year Quarterly Quarterly Every-other month Once a month As needed As needed Once a month 3 years CITY OF NEW RICHMOND BOARD, COMMISSION AND/OR COMMITTEE APPOINTMENT APPLICATION 3 years 5 years 5 years Airport Commission Board of Appeals Community Development Authority Ethics Board Forward New Richmond Historic Preservation Commission Housing Authority Library Board Public Works Committee Public Works Sub-Committee - Parks Public Works Sub-Committee - Infrastructure Public Safety Committee Plan Commission Police and Fire Commission Tourism Committee Utility Commission Urban Reserve Commission As needed 1 year EDUCATION: Indicate the highest year completed and degrees received: VOLUNTEER INFORMATION: Indicate any volunteer organizations you have served on in the past with name, address, phone and your position and title. PLEASE INDICATE YOUR REASONS FOR WANTING TO SERVE ON A BOARD: QUALIFICATIONS OR EXPERIENCE APPLICABLE TO THE PURPOSE AND SUBJECT MATTER OF THIS BOARD/COMMITTEE/COMMISSION: I declare that the information furnished herein above is true and correct to the best of my knowledge. Signature: Date: PLEASE SUBMIT APPLICATION TO: mscanlan@newrichmondwi.gov CITY OF NEW RICHMOND 156 EAST FIRST STREET NEW RICHMOND, WI 54017