Name
Date
Street Address
City
State
Zip Code
Telephone
Alternate Telephone
Email Address
Education
Occupation
I would like to be considered and could devote sufficient time to serve on the following Board(s), in order of preference
Please indicate experience and/or qualifications that would help make you an effective member of each board for which you have applied
Volunteer Experiences
I understand that appointment to a City of Portage Board or Commission requires attendance at all board meetings. Members with three unexcused absences will be referred to the City Council for review and possible dismissal.
Applicant's Signature