2. Date*
   Date

4. APPLICATION TO SERVE ON A BOARD/COMMITTEE

   
   

6. First Name*
7. Last Name*
9. Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number*
16. Daytime Phone Number*
18. Email Address*
20. Board/Committee you are applying for:*
    -- Select One --Affordable & Fair Housing PartnershipAgricultural CommissionAquifer Protection CommitteeBiodiversity Environment & Ecological Sustainability CommitteeBoard of AssessorsBoard of HealthBoard of Public WorksCharity Funds CommitteeCommission on DisabilityCommunity Preservation Act CommitteeCommunity Relations CommitteeConservation CommissionContributory Retirement BoardCouncil on AgingDevelopment & Industrial CommissionEasthampton City ArtsEasthampton Cultural CouncilEnergy Advisory CommitteeHistorical CommissionHousing AuthorityLicensing BoardMain Street Cemetery CommissionManhan Rail Trail CommitteeNashawannuck Pond CommitteeParks & Recreation CommissionPlanning BoardPublic Library Association of EasthamptonRanked Choice Voting Ad Hoc CommitteeRegistrar of VotersSchool Building CommitteeTelecommunications Advisory CommitteeVeteran's CouncilZoning Board of Appeals
21. How did you learn of this vacancy?*
23. Why are you interested in serving?*
25. Are you aware of this board’s time commitment, and are available on its regular meeting day? *

    1. Yes
    2. No
27. Have you served on any other City Board or Committee in the past? *

    1. Yes
    2. No
28. If yes, list the Board or Committee and year(s) served.
30. Letter of Interest (Upload Here)*

    In addition to filling out this application, please attach a letter stating your reasons and/or qualifications for seeking an appointment to this particular Board/Committee. (Include resume if appropriate.)

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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field