Thank you for your interest in serving on a Cedar Rapids Board or Commission. The purpose of this form is to provide the Mayor and City Council members with information about residents considered for appointment.

Name:
  First: Last:
Home Address:
  Street/Box: City: State: Zip:
Work Address:
  Street/Box: City: State: Zip:
Home Phone:
Business Phone:
Email:
Employer:
  Employer: Position/Occupation:

Regular attendance at scheduled Board/Commission meetings is expected of all appointed members. Members who miss more than three regularly scheduled meetings in a 12-month period may be removed from the Board/Commission unless extenuating circumstances can be demonstrated.

AREA OF INTEREST FOR APPOINTMENTS: In order of preference, please list the Boards and Commissions for which you are applying. All City Board and Commission information is available at www.cedar-rapids.org  under the Government page.

STATEMENT OF INTEREST: Briefly describe why you are interested in serving on this Board or Commission. The City Council will use this statement to assist in determining which candidates are best suited to fill Board and Commission vacancies. Feel free to include separate statements for each Board or Commission of interest.

SPECIAL QUALIFICATIONS: Please list any special qualifications for serving on a Board or Commission, including skills, training, licenses, and certificates that are applicable.

Please include your resumé or brief history of your experience and qualifications including education, community involvement and/or government and civil experience. (Optional) 

DEMOGRAPHIC INFORMATION: (Optional): Completion will help ensure progress towards the goal of demographic balance.

Age:

Gender:
Race / Ethnic Group:
Signature:
 Typing your name in this box represents your Signature.
Date:

Format: mm-dd-yyyy