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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.

Leave This Blank:


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