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2. Instructions
   Please complete the following to apply for appointment to City of Clearwater boards or commissions.
   
   Note: This application will remain active for three years from the date it is submitted.
4. First Name*
5. Last Name*
7. Street Address
9. Home Telephone
10. Work Telephone
12. Email Address*
13. How many years have you resided in Sedgwick County?
15. Are you a registered voter?

    1. Yes

    1. No
16. What board or commission are you applying for?

    1. Park Advisory Board

    1. Planning Commission
18. Why are you are interested?
    Please state why you are interested in serving on this board/commission/council and indicate what expertise and/or capabilities you would bring to this board/commission/council.
20. Other Boards or Elected Offices
    What other boards (city, county, school, hospital, etc.) or elected offices are you currently serving on or have you ever served on?
22. Community Activities
    What other boards (city, county, school, hospital, etc.) or elected offices are you currently serving on or have you ever served on?
24. Conflicts of Interest
    What other boards (city, county, school, hospital, etc.) or elected offices are you currently serving on or have you ever served on?
26. Additional Comments
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field