Admin Use: Received: Resident: Y N Ward: Appointed To: Appointment Date:
Town of Fort Mill
Application for Service on Town of Fort Mill
Board, Commission, or Committee
Applicant Information
Name of Applicant:
Street Address:
City:
State:
Zip Code:
Phone:
Email:
Do you live within town limits?
Yes
No Unsure
Years at current address:
Educational Background:
Current Occupation/Employer:
Committee Information
On which board, commission, or
committee are you interested in
serving? (Check all that apply.)
Stormwater Advisory Committee
Strawberry Festival Committee
Other
Other
Applicant Background
Do you have any special training
and/or experience that would
qualify you for this position?
Are you serving, or have you
served, on any governmental
board, commission or committee?
How many hours are you willing to
commit each month?
Reason for interest:
By submitting this form, I certify that all information included in this application is true and accurate:
Sign/Type Name:
Date:
Return Completed Form To:
MAIL: Town of Fort Mill, Attn. Virginia Burgess, 200 Tom Hall Street, P.O. Box 159, Fort Mill, SC 29716
FAX: (803) 548-4722 E-MAIL: vburgess@fortmillsc.gov