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2. Select the Board(s) or Committee(s) applying for

   1. Cole County Parks Committee
   2. Cole County Planning & Zoning Commission (4 year term)
   3. Cole County Board of Equalization
   4. Cole County Residential Special Services Board (3 year term)
   5. Enhanced Enterprise Zone (5 year term)
   6. Onsite Wastewater Treatment Board of Review (3 year term)
   7. Public Library Board (3 year term)
   8. Public Works Road and Bridge Advisory Committee (3 year term)
   9. Public Works Traffic and Safety Advisory Committee - Traffic (3 year term)
   10. 911 Joint Communications Advisory Committee
4. Please check if this is a*

   1. new appointment or
   2. reappointment
6. First Name*
7. Last Name*
9. Home Address*
11. City*
12. State*
13. Zip*
15. Phone (Home)*
16. Phone (Cell)
18. Email Address
20. Resident of Cole County?*

    1. Yes
    2. No
22. Relevent Work/Professional Experience
24. Involvement in Professional & Community Organizations
26. Previous Service on Boards & Committees (Include Dates & Positions)
28. Briefly describe why you are seeking appointment, and what skills/experience that you would bring to the board(s) or committee(s)
30. Upload Resume and/or letter here
32. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
34. Electronic Signature*
36. Thank you!
    Thank you for your interest. Applications will be kept for a period of two years after submission.
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38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit Submit and Print

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