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Volunteer Application Return to: 101 N. 4th Street / P.O. Box 1030 Douglas, WY 82633 [PHONE REDACTED], Fax: [PHONE REDACTED] Volunteer Application Page 1 of 2 I:\COMDOC\City Clerk\Boards & Commissions\Applications, Forms, Misc Docs & Lists\20230302 Application for Boards and Commissions.doc Name of Applicant: Address: City/State/Zip: Mailing Address (if different from above): Home Phone: Cell Phone: Work Phone: Email: 1. Are you a resident of the City of Douglas? ❑ Yes ❑ No 2. I am interested in serving on the following Boards/Commissions (Please all that apply): Boards/Commissions/Committees: ❑ Douglas Planning & Zoning Commission/Board of Adjustments ❑ Historic Preservation Commission ❑ Converse County Tourism Promotion Board ❑ Douglas Housing Authority Board ❑ Federal Urban Systems Advisory Committee ❑ Douglas Board of Appeals ❑ Steering Committee Member (when applicable) ❑ Focus Group Member (when applicable) ❑ Community Facility Task Force ❑ Arts & Culture Board of Trustees ❑ Recycling Task Force ❑ Other: 3. Have you served on any of these Boards/Commissions previously? ❑ Yes ❑ No 4. If “Yes”, please indicate which Boards/Commissions and when you served: 5. In what community/communities did you previously serve? ---PAGE BREAK--- Volunteer Application Return to: 101 N. 4th Street / P.O. Box 1030 Douglas, WY 82633 [PHONE REDACTED], Fax: [PHONE REDACTED] Volunteer Application Page 2 of 2 I:\COMDOC\City Clerk\Boards & Commissions\Applications, Forms, Misc Docs & Lists\20230302 Application for Boards and Commissions.doc 6. In what position(s) would you be willing to serve? (Please select all that apply.) ❑ Chairperson ❑ Vice Chairperson ❑ Secretary ❑ Treasurer ❑ Board, Commission, or Committee member only 7. Do you understand the attendance requirements as provided per Douglas Municipal Code and/or the Bylaws of the Board or Commission you wish to serve on? ❑ Yes ❑ No 8. If “No”, please provide a description of your question(s): 9. Why are you seeking this appointment(s)? Signature of Applicant Date For Office Use Only: Selected for: Length of Term/Dates: Additional Information: