application

GENERAL INFORMATION Name Last First Middle Address Street City State ZIP Home Phone: Cell Phone: Yes Name of Board or Commission you are applying for: Current Occupation: List any relatives in the service of any department of the Town of Grand Chute, and your relationship to them. If yes, provide date/s and type/s of conviction/s: Number of Years ServedName of Board, Commission, or Committee Board or Commission Application Are you at least 18 years old? older? E-mail address: Town of Grand Chute 1900 W Grand Chute Boulevard Grand Chute, WI 54913 PRIOR BOARDS, COMMISSIONS, OR COMMITTEE EXPERIENCE If selected, how would you work towards bettering the community through your service on the Board or Commission? No Have you ever been convicted of a crime other than minor traffic violations? No Yes List any potential conflicts of interest. Do you currently reside in the Town of Grand Chute? Yes No How many years have you lived in the Town of Grand Chute? Signature Date Optional: Attach your resume or letter of interest to supplement this applica tion. Please return this completed application and any other supplemental information to: Kayla Raatz, Town Clerk 1900 W Grand Chute Boulevard Grand Chute, WI 51913 Email: kayla.raatz@grandchutewi.gov Phone: 920-380-2952 Fax: 920-993-7032