Boards & Commissions Application

Boards & Commissions Application
Submission Date

MonthDayYear
Hour MinutesAM/PM Option
Should you have any questions about Boards and Commissions, call the Office of the City Clerk at 757-382-6151.
Select Board & Commission Preferences

I am interested in serving on one of the following three (3) boards/commissions.
First Preference
Second Preference
Third Preference
As an applicant/member of a Council-appointed Board or Commission, your name, address, and published phone number will be available to the press and public. Information will be kept on file for two years.
Personal Information
Salutation
Name

First NameMiddle InitialLast Name
Planning Area
Home Address (Required Filed)*

Street Address

Apartment Number

CityState

Zip Code
Phone Number (Primary)
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number (Secondary)
Please enter a valid phone number.Format: (000) 000-0000.
Email (Required Field)*
Occupation
Company/Organization Name
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Education, Experience, and Community Involvement
Education/Experience
Volunteer and/or Community Involvement
Additional Information
What do you feel you can contribute to the community that may not be evident from information already on this form?
Previous Service
Have you served on one of our Boards and Commissions previously? If so, please indicate the name and year.
Year
Submit Application
Please ensure you have a valid email address listed in the "Email Address" field.

By clicking on the "Submit" button, you certify that the above information is valid as of date of submission.
Should be Empty:

Boards & Commissions Application

Select Board & Commission Preferences

Personal Information

Education, Experience, and Community Involvement

Additional Information

Previous Service

Submit Application