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Boards and Commissions Application

2. First Name*
3. Last Name*
5. Home/Residential Address*
   Your home/residential/physical address
7. City*
8. State*
9. Zip*
11. City Council District*
    -- Select One --123Not a resident
12. Please visit the City's interactive online map to determine your City Council District
    City Council District Map
14. Email*
15. Cell Phone*
16. Home Phone
18. Business/Mailing Address
20. City
21. State
22. Zip
24. click here for a description of each Board and Commission and their function
26. I want to apply to serve on the following Boards and Commissions:*

    1. Appearance Review Committee
    2. Board of Adjustment
    3. CDBG Advisory Committee
    4. Development Advisory Committee
    5. Downtown Review Board
    6. Economic Development Council
    7. Historic Preservation Commission
    8. Human Relations Commission
    9. Industrial Development Authority
    10. Land Bank
    11. Park Commission
    12. Planning Commission
    13. Public Art Commission
    14. Public Safety Citizens' Advisory Board * Must be a graduate of the Citizen's Police Academy
    15. Solid Waste Management Commission
    16. Technical Review Committee
    17. TIF Commission
28. Please list your top three Boards and Commission selections in order of preference: *
30. If you are interested in the Public Safety Advisory Board, please list the year you graduated the Blue Springs Citizen's Police Academy.
32. My strenghts for serving on the Board/Commission will be:*
34. Education*
    High School, City, State, Dates attended
36. College/University
    Institution, Degree, Dates attended
38. Post Graduate
    Institution, Degree, Dates attended
40. Current Employment*
    Current Employer, Address, Position, Dates of Employment
42. Past Employment
    Past Employer(s), Address, Position, Dates of Employment
44. Community Involvement*
    Organization, Position(s), Membership Date(s)
46. Conflict of Interests*
    Do you have business or property interests that might place you in a conflict of interest situation should you be appointed to this Board/Commission? If so, please explain.
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48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field