Board and Commission Application

2. Application for the appointment to the (Board/Commission/Committee):*

4. Date:*

5. District:*

7. How long have you been a resident of Wheat Ridge?*

9. Are you a registered voter?*

   1. Yes
   2. No

11. Why are you seeking this appointment?*

13. Do you have experience in this area?*

15. Have you ever served, or are you currently on a Board/Commission/Committee and if so, which one? How long?*

17. Are there any conflicts which would interfere with regular attendance or duties?*

19. First Name*

20. Last Name*

22. Address1*

24. Address2

26. City*

27. State*

28. Zip*

30. Home Phone*

31. Business Phone

33. Email Address*

35. Your application will be kept on file for one year.
    City Clerk's Office, 7500 W. 29th Ave., Wheat Ridge, CO 80033

    City Clerk's Office, 7500 W. 29th Ave., Wheat Ridge, CO 80033

Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field