Board/Committee Application

Please complete this form if you are interested in serving on one of the City's Boards and/or Committees.

Your Full Name:

Your Current Mailing Address:

Your Current Street Address (if different than mailing):(optional)

Enter Your Phone Number:

Please Enter an Alternate Phone Number:(optional)

How long have you been a Waterville resident?

Your Occupation:

Please indicate which Boards/Committee you would like to be a member of:

ANY COMMITTEE

Board of Assessment Review

Fair Hearing Authority (f/k/a Health

Kennebec Sanitary Treatment District (KSTD) Trustees

Planning Board

Public Library Trustees

Waterville Housing Authority Commissioners

Waterville Sewerage District Commissioners

Board of Zoning Appeals

Haines Charity (Relief Committee)

Are you currently employed by the City full or part-time?

Yes

Please list your interests/skills that would benefit the committee(s) you indicated;

Please state why you wish to serve on a board/committee:

Please list one reference:

Please Enter a Phone number for Your Reference:

By typing your full name below you are signing this document and verifying all information entered is true:

Date Signed:

Would you would like confirmation that this form has been received? Please indicate below:

Yes

Your Email Address:(optional)

Please enter the security code below: