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Board and Committee Membership Application

2. 

3. APPLICATION FOR VOLUNTEERS (City Committees/Boards)
   <BR>City Manager's Office <BR>City Hall, 2nd Floor <BR>400 Washington Street <BR>Burlington, Iowa 52601 <BR><BR>Questions? (319) 753-8120

   
   City Manager's Office
   City Hall, 2nd Floor
   400 Washington Street
   Burlington, Iowa 52601
   
   Questions? (319) 753-8120

5. Thank you for your interest in serving on a Burlington Committee or Board. The purpose of this form is to provide the City Council members with information about residents considered for appointment.

   Thank you for your interest in serving on a Burlington Committee or Board. The purpose of this form is to provide the City Council members with information about residents considered for appointment.

7. First Name*

8. Last Name*

9. Today's Date*
   Today's Date

11. GENDER BALANCE
    Effective January 1, 2012, Section 69.16A of the Iowa Code requires gender balance on those City Boards and Commissions required or governed by state law unless the City has made a good faith effort to appoint a qualified person for a period of three months. The City Council of Iowa City has initiated the process of gender balance and has applied the process to all City Boards and Commissions.

    Effective January 1, 2012, Section 69.16A of the Iowa Code requires gender balance on those City Boards and Commissions required or governed by state law unless the City has made a good faith effort to appoint a qualified person for a period of three months. The City Council of Iowa City has initiated the process of gender balance and has applied the process to all City Boards and Commissions.

13. Gender*
    -- Select One --MaleFemale

15. Home Address*

17. City*

18. State*

19. Zip*

21. Employment*

23. Work Address

25. City

26. State

27. Zip

29. Email Address*

31. Home Phone

32. Work Phone

33. Cell Phone

35. Reason for Interest*

37. Please check when available for meetings*

    1. Day

    1. Evening
38. Expertise or Training in Area (if any/applicable)*

40. Check each Board/Commission that you have interest in serving on:*

    1. Airport Authority
    2. Animal Hearing Board
    3. Board of Housing Standards and Appeals
    4. City Planning Commission
    5. Civil Service Commission
    6. Construction Board of Appeals
    7. Economic Development Advisory Committee
    8. Flint Hills Golf Course Advisory Committee
    9. Historic Preservation Commission

    1. Human Rights Commission
    2. Library Board of Trustees
    3. Low Rent Housing Agency
    4. Parks Advisory Committee
    5. Renewable Energy Committee
    6. Riverfront Advisory Committee
    7. Tree Advisory Board
    8. Waterworks Board of Trustees
    9. Zoning Board of Adjustment

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42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

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