Boards and Commissions Reappointment Application

Current Size: 80%

Last Updated: May 17, 2016

Are you currently serving and interested in serving another term? Fill out this application below.

I am interested in continuing to serve on the following board/commission *

As an applicant/member of a Council-appointed Board or Commission, your name, address, and phone number will be available to the press and public. Information will be kept on file for three years. Public discussion of information contained herein may occur in the meeting at which appointments are considered by the City Council.

Title *

Last Name *

First Name *

Middle Initial

Home Address *

Zip Code *

Phone Number *

Alternate Phone *

Occupation *

Employer/Organization *

Email *

Number of years as a Harrisonburg resident *

How many years have you served *

How many terms have you served *

Additional Comments

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Boards and Commissions Reappointment Application