Form Center

2. Contact Information
4. First Name*
5. Last Name*
7. Address1*
8. Apt/Unit #
10. City*
11. State*
12. Zip*
14. Daytime Phone Number*
16. Preferred Email
18. Resident of the City since

    Month and Year

19. Age by December 31 of the application year
21. Present Occupation
22. Place of Employment
24. Educational Background
28. Community Organization and/or Professional Memberships
29. Current or Previous Service on City Boards
31. Reasons to be Considered for Appointment
32. What personal qualifications can you bring to the Board or Commission?
34. What do you hope to Accomplish or Contribute while serving on a committee?
35. Have you attended meetings in your area of interest?

    1. Yes
    2. No
37. Is a family member currently serving on a Board or Commission?

    1. Yes
    2. No
38. If YES, please describe name and board
40. Available Boards

    1. Advisory Parks & Recreation Board
    2. Animal Shelter Advisory Committe
    3. Diversity and Inclusion Committee
    4. Keep Saginaw Beautiful Board
    5. Library Board
    6. Planning & Zoning Commission
    7. Zoning Board of Adjustments
    8. Where Needed
42. First (1st) Choice
    -- Select One --Advisory Parks & Recreation BoardAnimal Shelter Advisory CommitteeDiversity and Inclusion CommitteeKeep Saginaw Beautiful BoardLibrary BoardPlanning & Zoning CommissionZoning Board of AdjustmentsWhere Needed
43. Second (2nd) Choice
    -- Select One --Advisory Parks & Recreation BoardAnimal Shelter Advisory CommitteeDiversity and Inclusion CommitteeKeep Saginaw Beautiful BoardLibrary BoardPlanning & Zoning CommissionZoning Board of AdjustmentsWhere Needed
44. Third (3rd) Choice
    -- Select One --Advisory Parks & Recreation BoardAnimal Shelter Advisory CommitteeDiversity and Inclusion CommitteeKeep Saginaw Beautiful BoardLibrary BoardPlanning & Zoning CommissionZoning Board of AdjustmentsWhere Needed
48. Agreement*

    1. I agree to the terms and responsibilities as described in the ordinance or resolution as an appointee for the committee for which I wish to serve.
50. Applicants may be asked to attend an interview to ensure the best candidate is selected
52. Signature*
53. Date*
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit Submit and Print

* indicates a required field