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2. Name
4. Street Address
6. City
7. State
8. Zip Code
10. Mailing address (if different)
12. Home Phone
13. Work Phone
14. Mobile Phone
16. Email Address
18. Preferred Method of Contact

    1. Home Phone

    1. Work Phone

    1. Mobile Phone

    1. Email
20. Education
22. Occupation
24. Volunteer Experience
26. Please indicate experience and/or qualifications that would help make you an effective member of each board for which you have applied:
28. Important Public Records Information
    All information submitted in this application is public information and subject to disclosure to a public records request made pursuant to the Freedom of Information Act (FOIA).
30. Acknowledgment
    I understand that appointment to a City of Portage Board or Commission requires attendance at all board meetings. Members with three (3) unexcused absences will be referred to the City Council for review and possible dismissal.
32. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
34. Electronic Signature
35. Date
    Date
39. Boards and Commissions - Areas of Interest
    Instructions: Please review the desired qualifications for each board and commission. Check the appropriate box or boxes to indicate whether you have experience or professional credentials. Rank your preferred board by first, second, or third choice.
41. Rank
    -- Select One --123
42. Board of Review
    Members must have interest in property located in the City and experience in matters related to real estate.
43. Experience

    1. Banking/Finance
    2. Property Appraisal/Assessing
    3. Real Estate/Development/Law
45. Rank
    -- Select One --123
46. Construction Board of Appeals
    Members must be registered contractors with the City and qualified in matters relating to construction.
47. Experience

    1. Building OR Mechanical Contractor
    2. Professional Engineer OR Architect
    3. Master Electrician
    4. Master Plumber
49. Rank
    -- Select One --123
50. Downtown Development Authority
    A majority of members must have interest in property located in the district. Members must have experience in matters related to redevelopment.
51. Experience

    1. Economic Growth/Redevelopment
    2. Finance
53. Rank
    -- Select One --123
54. Economic Development Corporation/Tax Increment Finance Authority & Brownfield Redevelopment Authority
    Members must be qualified by experience in matters related to redevelopment.
55. Experience

    1. Commercial Banking
    2. Commercial Real Estate/Development/Law
    3. Economic Development
    4. Environmental Engineering/Consulting/Law
57. Rank
    -- Select One --123
58. Environmental Board
    Members should have interest or qualifications in matters related to the environment and protection of groundwater resources.
59. Experience

    1. Environmental Engineering/Consulting
    2. Water Quality
    3. Sustainability/"Green" Living
61. Rank
    -- Select One --123
62. Historic District Commission
    Members should have interest or qualifications in matters related to historic preservation.
63. Experience

    1. Construction/Building Trades
    2. History
    3. Architecture
65. Rank
    -- Select One --123
66. Human Services Board
    Members should have interests or qualifications in matters related to public assistance.
67. Experience

    1. Human/Public Services
    2. Public Transportation
    3. Community Development Block Grants (CDBG)
69. Rank
    -- Select One --123
70. Local Development Finance Authority
    Includes one (1) member appointed by the Kalamazoo County Board of Commissioners; one (1) member appointed by Kalamazoo Valley Community College; and two (2) members appointed by Portage Public Schools.
71. Experience

    1. Banking/Finance
    2. Economic Growth/Redevelopment
    3. Finance
73. Rank
    -- Select One --123
74. Local Officers Compensation Commission
    Members should have knowledge in matters related to public service.
75. Experience

    1. Local Government
    2. Compensation
77. Rank
    -- Select One --123
78. Park Board
    Members can have interests in a variety of disciplines.
79. Experience

    1. Fitness/Recreation
    2. Forestry
    3. Landscape Architecture
    4. Physical Education
81. Rank
    -- Select One --123
82. Planning Commission
    Members should have experience in matters related to land use and community development.
83. Experience

    1. Civil Engineering/Landscape Architecture
    2. Land Use Planning
    3. Real Estate/Development
    4. Law
85. Rank
    -- Select One --123
86. Senior Citizens Advisory Board
    Must be at least fifty (50) years of age and have an interest in the rights and abilities of older people to maintain wellbeing and independence.
87. Experience

    1. Services to Aging Persons
    2. Accessibility Issues
    3. Heathcare
89. Rank
    -- Select One --123
90. Zoning Board of Appeals
    Members must be qualified by experience in matters related to construction, land use planning and/or zoning.
91. Experience

    1. Building Construction/Engineering
    2. Land Use Planning
    3. Real Estate/Development/Law
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93. 1. Receive an email copy of this form.
94. Email address

    This field is not part of the form submission.

95. Submit

* indicates a required field