Thank you for your continued interest in serving on your Board/Commission. Please complete the following application by August 14th.

Today's Date (mm/dd/yyyy):*

Personal Information

Current Board or Commission *

Select One Animal Shelter Advisory Board Arts & Humanities Commission Board of Adjustment Community Investment Advisory Board Economic Development Advisory Board Golf Advisory Board Library Advisory Board Parks and Recreation Advisory Board Planning and Zoning Commission Rowlett Diversity Commission Senior Advisory Board (must be 60 years or older)

Other than your current Board/Commission, do you have a second choice for appointment?*

Select One Animal Shelter Advisory Board Arts & Humanities Commission Board of Adjustment Community Investment Advisory Board Economic Development Advisory Board Golf Advisory Board Library Advisory Board Parks and Recreation Advisory Board Planning and Zoning Commission Rowlett Diversity Commission Senior Advisory Board (must be 60 years or older)

Board/Commission Member's Name:*

Home Address:*

ZIP Code:*

Home Phone Number:*

Business Phone Number:

Cell Phone:

Email Address:*

Residency Information

Length of Residency in Rowlett:*

Are you a registered voter in Rowlett? (All members of citizen boards and commissions must be registered voters, residing in the City of Rowlett. This does not apply to Junior Alternate Members):*

Yes

No

If yes, what is your registration number:

Birthday (mm/dd/yyyy)*

Service Information

How has your Board/Commission benefited the community during your period of service?*

What suggestions do you have on making this Board/Commission more effective in the future?*

If you should be reappointed to your Board/Commission, what would you like to see going forward - what would you like to accomplish?*

List any specific skills, abilities, and contributions you have personally made to your Board/Commission during your current service?*

Select a Board/Commission on which you have previously served:*

Select One No previous service Animal Shelter Advisory Board Arts & Humanities Commission Board of Adjustment Community Investment Advisory Board Economic Development Advisory Board Golf Advisory Board Library Advisory Board Parks and Recreation Advisory Board Planning and Zoning Commission Rowlett Diversity Commission Senior Advisory Board (must be 60 years or older)

By affixing my initials, I understand that submission of this form does not guarantee a reappointment to my current Board/Commission; but expresses my interest in continuing to serve my community.