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Board/Commission Application Form

2. Date of Application 00/00/0000

4. First Name*

5. Last Name*

7. Address*

8. City*

10. State*

11. Zip*

12. Home or Cell Phone Number*

13. Time Living in Wichita Falls*

15. Email Address

17. Select the Board, Commission, or Committee applying for*
    -- Select One --Select OneLake Wichita Revitalization Committee4A Board4B Sales Tax CorporationAirport Board of AdjustmentAnimal Shelter Advisory CommitteeConstruction Board of Adjustment and AppealsEmergency Medical Service Advisory BoardFirefighters and Police Officers Civil Service CommissionHelen Farabee Regional MHMR Board of TrusteesHousing AuthorityLandmark CommissionLibrary Advisory BoardPark BoardPlanning and Zoning CommissionTIF Board Zone #2TIF Board Zone #3TIF Board Zone #4Water Resources CommissionWichita Appraisal DistrictWichita Co.-City of Wichita Falls Hospital BoardWichita Falls-Wichita Co. Health District BoardWichita-Wilbarger 911 DistrictZoning Board of Adjustment

18. Council District

    1. District 1
    2. District 2
    3. District 3
    4. District 4
    5. District 5
    6. Unknown

20. Currently Serving on a City Board or Commission?*

    1. Yes
    2. No

21. Name of Board or Commission Currently Serving

23. Board or Commission Formerly Served*

25. Employer-Job Title or Business Owned*

26. Business-Employment Address*

28. City, State, Zip

29. Business/Employment Phone

31. College

32. Are You a Veteran

    1. Yes
    2. No

34. Current organizations served, other than a City Board or Commission, and position held*

36. Other community involvement

38. What motivates you to serve?*

40. Please list special experience/knowledge that will enhance your service

42. Age-Optional

    1. 18-25
    2. 25-34
    3. 35-44
    4. 45-54
    5. 55-64
    6. 65-

43. Gender-Optional

    1. Female
    2. Male

44. Race-Optional

Leave This Blank:


45. Submit Submit and Print

* indicates a required field