Village of Clemmons Committe Application

APPLICATION FOR

BOARDS, COMMISSIONS AND AD-HOC COMMITTEES

Applying for:

___Appearance Commission

___Planning Board

___Stormwater Advisory Board

___ Zoning Board of Adjustments

___ Ad-Hoc Committee for _____________________________

Name: ______________________________________________________________

Resident Address:_______________________________________________________

Mailing Address:________________________________________________________

E-mail Address:_________________________________________________________

Home Phone:_____________________ Business Phone:________________________

PERSONAL INFORMATION

High School Attended:____________________________________________________

College:_________________________________ Degree:________________________

Employer:_______________________________________________________________

Job Title:________________________________________________________________

Describe Work Experience:__________________________________________________

_______________________________________________________________________

PRIOR CIVIC SERVICE

Board/Commission/Civic Organization From To

______________________________________________ ____________ ____________

Describe Civic

Experience:_______________________________________________________________

________________________________________________________________________

COMMENT

(Statement of why you want to serve)

________________________________________________________________________

The Village of Clemmons appreciates very much your interest in volunteering your services to our community.

If appointed by the Village Council, you are willing to serve on the committee for which you are applying.

_________________________________

Signature of Applicant

_________________________________

Date