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2. This form is used to apply to City of Whitewater Boards, Committees or Commissions.
4. Date*
   Date
6. Applicant Information
8. First Name*
9. Last Name*
11. Home Address*
13. City*
14. State*
15. Zip Code*
17. Home Phone Number*
18. Cell Number*
20. Email Address*
22. Boards/Committees/Commissions of Interest
24. Select all Boards, Committees & Commissions you are applying for by checking each box:*

    1. Board of Zoning Appeals
    2. Community Development Authority
    3. Community Involvement & Cable TV Commission
    4. Disability Rights Commission
    5. Equal Opportunities Commission
    6. Ethics Committee
    7. Landmarks Commission
    8. Library Board
    9. Parks & Recreation Board
    10. Pedestrian & Bicycle Advisory Committee
    11. Plan & Architectural Review Commission
    12. Police & Fire Commission
    13. Urban Forestry Commission
    14. Whitewater University Technology Park Board
    15. Aquatic Center Committee (ACC)
26. Give a brief overview of your background, experience, interest, or concerns pertaining to the selected board(s), committee(s) or commission(s).*
28. Optional: Upload supportive documents (resume, recommendation letter, etc.)
30. Indicate whether you are available during the day or the early evening for a short interview with the City Manager & Common Council President.
32. Business/Employer Information
34. Business/Employer Name*
36. Business/Employer Address
38. City
39. State
40. Zip Code
42. Business/Employer Phone Number
44. Reference #1 Full Name*
46. Reference #1 Address & Phone Number*
48. Reference #2 Full Name*
50. Reference #2 Address & Phone Number*
52. Regular Board, Committee and Commission members are expected to attend at least three-quarters of the meetings each year. Alternate members are always welcome to attend all meetings, but are not required to attend meetings unless requested.
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit Submit and Print

* indicates a required field