Application for Appointment

2. 

3. Application for Appointment

5. Boards & Commissions*
   -- Select One --Affordable Housing CommissionArts CommissionBuilding Appeals BoardCable Television CommissionCivil Service CommissionEllensburg Business Development AuthorityEnvironmental CommissionLandmarks and Design CommissionLibrary BoardLodging Tax Advisory CommitteeParks and Recreation CommissionPlanning CommissionPublic Transit Advisory CommitteeSenior Citzens Advisory CommissionUtility Advisory Commission

7. Name of Applicant:*

9. Address*

11. Mailing Address (If Different)

13. City*

14. State*

15. Zip*

17. Email Address*

18. Phone Number*

20. Length of Residence in Ellensburg*

21. Do you live within the city limits?*

    1. Yes

    1. No

23. If applying for the Sr. Citzens' Advisory Board, are you at least 55 years of age?

    1. Yes

    1. No

25. Occupation Status and Background:*

27. Organization Affiliations:*

29. Why are you seeking appointment?*

31. Will you be able to attend meetings regularly if appointed?*

    1. Yes

    1. No

33. If your first choice, as listed above, is not available, which other boards or commissions would you be interested in serving on?

35. Boards & Commissions
    -- Select One --Arts CommissionBuilding Appeals BoardCable Television CommissionCivil Service CommissionEllensburg Business Development AuthorityEnvironmental CommissionLandmarks and Design CommissionLibrary BoardLodging Tax Advisory CommitteeParks and Recreation CommissionPlanning CommissionPublic Transit Advisory CommitteeSenior Citzens Advisory CommissionUtility Advisory Commission

37. Boards & Commissions
    -- Select One --Arts CommissionBuilding Appeals BoardCable Television CommissionCivil Service CommissionEllensburg Business Development AuthorityEnvironmental CommissionLandmarks and Design CommissionLibrary BoardLodging Tax Advisory CommitteeParks and Recreation CommissionPlanning CommissionPublic Transit Advisory CommitteeSenior Citzens Advisory CommissionUtility Advisory Commission

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38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field