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4. APPLICATION FORM MONTPELIER CITY BOARDS AND COMMITTEES
   Please use this form to express your interest in serving on a particular board/committee or commission. For information on our boards and committees, please visit https://www.montpelier-vt.org/committeevacancies. The Montpelier City Council makes appointments to board/committees at their regular meetings as vacancies occur. Completed applications are public documents and are subject to the Vermont Public Records Act.
6. The Montpelier City Council is committed to seeking diversity on all boards, committees and commissions, including but not limited to geographic, racial, gender, cultural, age, socio economic diversity. Montpelier residency for applicants is preferred but not required.
   *Applications must be received the Friday prior to the scheduled council meeting to be considered by the City Council for appointment.
8. Name*
9. Email Address*
11. Address
13. City
14. State
15. Zip Code
17. Phone Number
18. Occupation
20. Are you 18 years of age or older?*

    1. Yes
    2. No
21. Are you a registered voter in the City of Montpelier?*

    1. Yes
    2. No
22. Are you a resident of the City of Montpelier?*

    1. Yes
    2. No
23. How long have you been a resident of the City of Montpelier?*
25. Are you related to any elected City Councilor (including by marriage)?*

    1. Yes
    2. No
26. Do you have any pending litigation against the City?*

    1. Yes
    2. No
28. Name of City Board or Committee: (If applying for more than one board/committee, please list order of preference)*
30. Are you currently serving or have you served on any City board or committee? If so, please list and give approximate dates.*
32. Please answer each question in as much detail as possible.
34. Education/Credentials:
36. Professional activities that relate to this board/committee:
38. Community activities that relate to this board/committee:
40. Why are you interested in serving on this board/committee?
42. What talents or experience would you bring to the board/committee?
44. Any other comments or information you wish to provide to the Mayor and City Councilors?
46. Are you involved in any personal, professional or business pursuit that would affect your ability to make fair and impartial recommendations as a member of a City advisory board or committee? *

    1. Yes
    2. No
47. If you answered yes, please explain:
49. ACKNOWLEDGMENT*

    1. I have read and accept the terms of board/committee appointment.

    By checking this box, I acknowledge that regular attendance (not missing more than 3 consecutive meetings or 1/3 of all meetings), active participation and contribution to the group’s goals and mission, as well as adherence to open meeting laws and public record laws are requirements of me as a committee member. I acknowledge that if I do not meet the requirements stated above, that my appointment may be reconsidered.
51. By e-signing this application, I certify that there are no misrepresentations, omissions or falsifications on this application.*
52. 
    
    Submitted on:*
    
    
    Submitted on:
54. Thank you for your interest in serving the City of Montpelier as a volunteer board or committee member. Your willingness to serve is greatly appreciated.
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field