Form Center

2. First Name*
3. Last Name*
5. Organization Name (IF APPLICABLE)
7. Address1*
9. Address2
11. City
12. State
13. Zip*
15. Phone Number*
16. E-Mail Address*
18. In which City Council District do you reside?
20. City Council District*

    1. District 1
    2. District 2
    3. District 3
    4. District 4
    5. Partner Organization (Healthy West Valley Only)
21. To view a map of the current City Council boundaries, follow this link.
    LINK
23. Which Boards or Committees are you interested in participating on (top 3 areas of interest)?*

    1. Administrative Review Board
    2. Board of Adjustments
    3. Clean & Beautiful Committee
    4. Healthy West Valley Committee
    5. Historical Preservation Commission

    1. License Hearing Board
    2. Planning Commission
    3. Professional Standards Review Board
    4. Sister City Committee
25. Reason for your interest in this board or committee?*
27. How did you hear about this board or committee?*
29. Are you currently serving on any other City board or committee?*

    1. Yes

    1. No
31. If yes, which board or committee?
32. Have you had previous experience serving on a city board or committee?*

    1. Yes

    1. No
34. If yes, please explain.
36. Please list any community service / activities (past and present).*
38. Please list any professional activities.*
40. Please list any civic / professional organization memberships.*
42. Please list up to 3 references along with their contact information.*
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44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

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