– Application for Service on Maricopa County Boards and Commissions –
Name: Date:
Residential Address: _______________________________________________________________
City/State/Zip: _____________________________________________________________________
Business Name: ____________________________________________________________________
Occupation: ________________________________________________________________________
Address: __________________________________________________________________________
City/State/Zip: ______________________________________________________________________
Phone Numbers: Home: _______________ Work: _______________ Fax: ________________
Email: _____________________________________________________________________________
I would like to serve on the following Board/Commission(s):
1) ________________________________________________________________________________
2) ________________________________________________________________________________
3) ________________________________________________________________________________
4) ________________________________________________________________________________
Some Boards and Commissions have special requirements concerning representation (i.e. degrees,
occupation, licensing, etc.) Please list any areas of specialty that you may have:
Why I believe my service would benefit this Board/Commission:
Please submit applications to the Clerk of the Board via mail, email or fax.
For more information about Maricopa County Boards and Commissions visit: www.maricopa.gov/Boards/
Maricopa County Clerk of the Board of Supervisors
301 W. Jefferson, 10th Floor, Phoenix, AZ 85003
Phone: 602-506-3766, Fax: 602-506-6402
Email: BoardsandCommissions@maricopa.gov
