CITIZEN LEADERSHIP & VOLUNTEER FORM

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Name *

Date *

YYYY

Home Address (not subject to public disclosure) *

Phone (not subject to public disclosure) *

Fax or Email

Business Address

Business Phone

Business Fax or Email

I would like to be considered for the following Board(s) or Committee(s) as a Volunteer Member *

Cable Television Advisory Committee

Agricultural Advisory Board

Board of Health

Economic Development Committee

Advisory (Business) Member, Economic Development Committee

Environmental Commission

Green Team

Historic Preservation Commission

Library Board of Trustees

Municipal Utility Authority

Open Space Committee

Planning Board

Recreation Advisory Committee

Shade Tree Committee

Trail Committee

Zoning Board of Adjustment

Required

Education Background *

Relevant Work Experience *

Involvement in Professional and Community Organizations *

Previous Service on any board(s) or committee(s), include dates and position(s) *

Describe briefly why you are seeking the appointment *

Certify the information provided above is true by entering your name below *

Submit

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