Information provided on this from will be a public record subject to free and open
examination by any person under the Arkansas Freedom of Information Act.
Applicant Information:
Name: Telephone Number:
Physical Address: Alternate Number:
State: E-mail Address:
Zip Code: Length of Residency in Little Rock:
Are you registered to vote in the City of Little Rock? Yes No
Position Seeking:
State your experiences, elements of your employment history and interests that qualify you for this advisory
Describe education history, past volunteer experiences, professional certifications and licensences:
Please upload a current resume with your application. Submit forms to: Little Rock City Clerk's
Office, 500 West Markham Street, Room #200, Little Rock, AR 72201; by e-mail to
or by fax to (501) 371-4857.
Board and Commission meetings may require day or evening attendance. For more information
regarding boards and commissions, including meeting times and duties, please visit
Self-Identification Survey
The City of Little Rock and the Racial and Cultural Diversity Commission seeks to increase diversity
in applicants for City Boards and Commissions. Your demographic information will be used to track
and enhance diversity in our Boards or Commissions.
Race/Ethnic Group:
Black or African American
Hispanic or Latino (of any race)
American Indian or Alaskan Native
Native Hawaiian or Other Pacific
Male Female
18-25 26-35 36-45 46-55 56+
How did you learn of this Board/Commission vacancy?
City Website Newspaper
Community Agency Referred by Board/Commission Member
Local Government Access Channel Referred by City Director or Staff
The City Code of Ethics prohibits any the member of any City Board, Commission or Authority, form
voting on a matter in which the member has an interest, or the member's family or business has an
interest. If such a matter comes before the body to which you are appointed, and there is any
question about recusal, you should contact the City Attorney's Office for an informal or formal
opinion as to the propriety of your participation.