Board/Commission Application Form

2. Select the Board, Commission, or Committee applying for*
   -- Select One --Select OneAirport CommissionBlue Ridge Community College BoardBuilding Code Appeals, Board ofCAP-SAWCentral Shenandoah Valley District Planning CommissionCultural CommissionDisability Services BoardEconomic Development AuthorityHistorical CommissionLibrary Board of TrusteesPlanning CommissionRedevelopment and Housing AuthorityRecreation CommissionSenior Advocacy CommissionShenandoah Valley PartnershipSocial Services Advisory BoardStormwater and Flood Control CommissionTransportation Safety CommissionValley Community Services BoardYouth CommissionZoning Appeals, Board of

   Please complete a separate application for each appointment you are considering. Please note that some boards and commissions require the completion of a financial disclosure form.

4. Personal Information

6. First Name*

7. Last Name*

9. Address1*

11. Address2

13. City*

14. State*

15. Zip*

17. Phone Number (Please Specify Home/Mobile/Business)*

19. Email Address

21. Residency Information

23. Are you a resident of Waynesboro?*

    1. Yes
    2. No

25. Education and Hobbies

27. Background and Qualifications

29. Experience and/or Profession:

31. Reason for wanting to serve:

33. Organization Membership Information

35. Are you currently serving on other Boards, Commissions, or Committees?*

    1. Yes
    2. No

37. If yes, which

39. Have you served on a Board, Commission, or Committee before?*

    1. Yes
    2. No

41. If yes, which

Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit Submit and Print

* indicates a required field