Form Center

2. Application to Serve on a County Board/Committee/Commission
4. First Name
5. Last Name
7. Address
9. City
10. State
11. Zip Code
13. Phone Number
14. Fax Number
16. Email Address
18. Employer
19. Phone
21. Business Address
23. Education
    Diploma/Degree and School Attended
25. Civic Activities (include other Boards/Committees/Commissions)
27. Membership in Fraternal, Business, Church or Social Organizations (include offices held)
29. Reason(s) you desire to serve on a Board/Committee/Commission
31. Are you a Graduate of a Leadership Academy? If so, please specify
32. Class of
34. Indicate your Board/Committee/Commission First Choice
    -- Select One --Agricultural and Forestal Districts Advisory Committee (AFD)Board of Building Adjustments and AppealsBoard of EqualizationBoard of Zoning AppealsChesapeake Bay BoardClean County CommissionColonial Behavioral HealthColonial Group Home CommissionCommunity Action AgencyEconomic Development Authority (EDA)Historic Triangle Bicycle Advisory CommitteeHistorical CommissionNew Town Design Review BoardParks & Recreation Advisory CommissionPeninsula Agency on AgingPlanning CommissionPurchase of Development Rights Program - Committee MembersSocial Services Advisory BoardStormwater Program Advisory CommitteeVirginia Peninsula Community College Local BoardWetlands BoardWilliamsburg Area Arts CommissionWilliamsburg Regional Library Board of Trustees
36. Indicate your Board/Committee/Commission Second Choice
    -- Select One --Agricultural and Forestal Districts Advisory Committee (AFD)Board of Building Adjustments and AppealsBoard of EqualizationBoard of Zoning AppealsChesapeake Bay BoardClean County CommissionColonial Behavioral HealthColonial Group Home CommissionCommunity Action AgencyEconomic Development Authority (EDA)Historic Triangle Bicycle Advisory CommitteeHistorical CommissionNew Town Design Review BoardParks & Recreation Advisory CommissionPeninsula Agency on AgingPlanning CommissionPurchase of Development Rights Program - Committee MembersSocial Services Advisory BoardStormwater Program Advisory CommitteeVirginia Peninsula Community College Local BoardWetlands BoardWilliamsburg Area Arts CommissionWilliamsburg Regional Library Board of Trustees
38. Indicate your Board/Committee/Commission Third Choice
    -- Select One --Agricultural and Forestal Districts Advisory Committee (AFD)Board of Building Adjustments and AppealsBoard of EqualizationBoard of Zoning AppealsChesapeake Bay BoardClean County CommissionColonial Behavioral HealthColonial Group Home CommissionCommunity Action AgencyEconomic Development Authority (EDA)Historic Triangle Bicycle Advisory CommitteeHistorical CommissionNew Town Design Review BoardParks & Recreation Advisory CommissionPeninsula Agency on AgingPlanning CommissionPurchase of Development Rights Program - Committee MembersSocial Services Advisory BoardStormwater Program Advisory CommitteeVirginia Peninsula Community College Local BoardWetlands BoardWilliamsburg Area Arts CommissionWilliamsburg Regional Library Board of Trustees
40. This application will be kept on file for two years. Thank you for applying.
44. For Official Use Only
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit Submit and Print

* indicates a required field