EmailMe Form - City Council Appointment to Boards and Commissions

Applicant Name *

First MI Last Suffix

Address *

Street Address City State / Province / Region Postal / Zip Code

If you reside outside the boundaries of the City of Terre Haute, please indicate in the ADDITIONAL INFORMATION comment box at the end of the form if you own property within the City of Terre Haute and the address. A few of the boards and commissions have requirements for residency. Please read the information on the City's website (under the City Council) for residency requirements prior to submitting this form.

Length of residency *

Less than one year

1-2 years

3 years or more

Phone *

### - ### - ####

Email *

Age Verifciation *

Less than 18 years of age

18-20 years of age

21 years of age

Please select one

Board or Commission applying for appointment *

Animal Control Commission

Human Relations Commission

Information Technology Advisory Board

Police Merit Board

Redevelopment Commission

THRIVE Steering Committee

Board of Zoning Appeals

Please select the board or commission you are applying for appointment. You may only SELECT ONE board or commission per appointment form.

EMPLOYMENT INFORMATION

Please read instructions carefully

Applicant employment and other appointed positions (Select all that apply)

I am appointed to other government boards or commissions

I am an employee of a town, township, city, county, state or federal office or agency

I am retired from a police or fire department

None of the above apply

There are restrictions for employment, past or present, or appointments for some boards and commissions. Please read the information on the City's website (under City Council) concerning the board or commission you are applying for prior to submitting this form. You may include additional information in the ADDITIONAL INFORMATION comment box at the end of the form

COMMENT BOXES

Please describe your qualifications to serve on the board or commission. You are limited to 250 characters.

Additional information you would like to submit with your application. You are limited to 250 characters