Fillable Board Application UPDATEDpdf2 - Board Application (004)

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Board Application UPDATEDpdf2 - Board Application (004)

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Received:
Appointed to:
Date Approved:
Term Dates:
APPLICATION
FORBOARDS ANDCOMMISSIONS
CITYOFCOLUMBIA
SOUTHCAROLINA
Board o
r
Co
m
m
iss
i
on fo
r
wh
i
ch
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ou a
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e a
p
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lying:
r
ea of know
l
edge as
i
t pertains to th
i
s boa
r
d/commission:
You
r
Na
m
e (
L
ast, F
i
r
st M
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d
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e) Race Gen
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r
Age County Co
u
ncil D
i
strict:
Res
i
dential
dd
r
ess C
i
ty State
South Carolina
Z
i
p
Code
Mailing
ddress C
i
ty State
South Carolina
Z
i
p
Code
You
r
Occupation – Title
B
u
siness Phone
Res
i
d
ence/Mo
b
i
l
e
Phone
E
m
p
l
o
y
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r
Na
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e
E-Mail Address
E
m
p
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r
ddress C
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ty State Z
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Code
E
m
ergenc
y
Point of Contact Relationship Contact Nu
m
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r
GENERAL QUALIFICATIONS
Are you a resident of the city?
Yes No
How long?
Recommended
by:
Why would you like to serve on this board or commission?
Do you presently serve on any
Commissions
/ Boards of the City / County / State? If so, please list.
Have you formerly served on any
Commissions
/ Boards of the City / County / State? If so, please list.
Are you currently in a position of responsibility with an organization or board that has received or is seeking funding
from the City of Columbia? If so, list the position and date.
Please list any Community Activities that you are involved in.
What are your goals and objectives if appointed to the Commission / Board?
If appointed I am eligible to serve on no more than one (1) board/commission with a maximum of two (2)
terms. I understand that this application will be on file for no longer than two (2) years.
Signature Date
RETURN
COMPLETED
FORM TO:
FOR OFFICE USE ONLY
City of Columbia
ATTN:
Ashley Jenkins
Post Office Box 147
Columbia, SC 29217
Email: Ashley.Jenkins@columbiasc.gov
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Board Application UPDATEDpdf2 - Board Application (004)

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Completed 12 July 2020

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