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2. Choose a Committee

   Number the committees listed below in order of interest for appointment, with 1 as the most interest and 5 as the least interest.

6. Board of Adjustment
   5-year term; meets as needed.
7. Board of Appeals
   5-year term; meets as needed.
9. Park Board
   3-year term; meets every 3rd Thursday of the month.
10. Planning and Zoning Commission
    5-year term; meets every 2nd and 4th Tuesday of the month.
12. Public Art Advisory Commission

    1- to 3-year term; meeting time TBD

14. NOTE: The Library Board of Trustees has a separate application process.
18. First Name*
19. Last Name*
21. Full Legal Name*
23. Date of Birth*
    Date of Birth
25. Street Address*
27. Mailing Address (if different than above)
29. City, State and Zip
    Waukee, IA 50263 (Must be a Waukee resident)
31. Home Phone*
32. Email Address*
34. Business Phone
35. Cell Phone
39. Personal Information*
    Please type your gender into the box above. This form assists the Mayor and City Council in evaluating the qualifications of applicants for appointment to a board, commission or committee. State law requires political subdivisions to make a good faith effort to balance appointive boards, commissions, committees and councils authorized by the Code of Iowa according to gender.
41. Employment/Volunteer Work*
    Please list your place of employment and/or activities such as hobbies, volunteer work, etc. that you feel may qualify you for this appointment.
43. Your Interest*
    Please describe why you are interested in serving on a City of Waukee board/commission/committee.
45. Supporting Information
    Please include any other information that supports your interest.
47. Your Contributions*
    What contributions do you feel you can make?
49. References*
    Please provide at least two references who may be contacted on your qualifications for this appointment. Please include name, address, phone number, email address and your relationship to them.
53. Signature*

    1. Signature

    I certify that there is nothing that would prohibit me from serving on a City of Waukee board, commission or committee. My application will be retained for one year. This application is a public document and as such can be viewed, reproduced or distributed to the public.
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55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field