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2. Board/Commission/Committee applying to
4. Applicant's First Name
5. Applicant's Last Name
7. Subdivision
9. Address
11. City
12. State
13. Zip Code
15. Phone Number
16. Fax Number
18. Email Address
20. Please state your interest in serving on this board/commission
22. Have you ever served on a board or commission for the Town of Summerville?

    1. yes
    2. no
23. If yes, provide information
25. Have you ever served on a board or commission for another city, county, or state?

    1. yes
    2. no
26. If yes, provide information
28. Have you ever served as an elected official of local government?

    1. yes
    2. no
29. If yes, specify what type of service
31. Education
33. Occupation (If retired, state former occupation)
35. Please describe how your educational background, work experience, or other life experience qualify you to contribute to the mission of this board
37. Professional affiliations
39. Service club/association memberships
41. Is there any way that you or a member of your family would stand to benefit financially by your service on this board or commission?

    1. yes
    2. no
42. If yes, explain
44. I hereby certify that the information above is true and accurate*

    1. yes
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46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field