Salt Lake City Boards and Commissions Application
Have a question about your application? Contact Simone Butler (801) 535-7743
Alternative formats of this application are available upon request. Contact (801) 535-7697 for accommodations.
Full Name *
Application Date *
MM
/
DD
/
YYYY
Address *
Council District - if you do not know your district click here https://bit.ly/2IUlRZ7 *
Phone Number *
Email Address *
Occupation and Employer *
Committees, Boards, Commissions, or authority you are interested in: *
Required
Reason for your interest in this particular committee, board, commission or authority *
Are you currently serving on any other city committees? *
Have you had previous contact with the committee/board/commission/authority you are applying for? *
Community service/activities (past and present) *
Civic/professional organization memberships *
Ethnic group
Gender/gender identity
Are you a Veteran of any branch of the United States Armed Forces
Do you consider yourself to be a member of the disability community?
Please list three references with their phone numbers *
Please attach your resume *
Required
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