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2. Appointed Board Form Consideration

   The Town has several appointed Boards and Committees that serve to assist the Town Board of Commissioners in governing and setting policy of the Town (see website). The members consist of town residents and extraterritorial jurisdiction residents. Members are recommended by the Mayor and approved by the Town Board of Commissioners. In some cases, the extraterritorial jurisdiction members must also be approved by the Wake County Board of Commissioners.

4. First Name*
5. Last Name*
7. Address1*
9. Address2
11. City*
12. State*
13. Zip*
15. Email Address*
16. Phone Number*
18. Occupation:
19. Name of Employer:
21. I reside:*

    Only residents of the town limits or Fuquay-Varina extraterritorial jurisdiction are eligible to serve on Town advisory boards.  Please indicate where you live. 

    1. Within town limits of Fuquay-Varina
    2. Within the extraterritorial jurisdiction of Fuquay-Varina
23. I am interested in serving on the following board(s)*

    1. Planning Board
    2. Board of Adjustment
    3. Parks and Recreation Board

    1. Friends of the Arts Board
    2. Other committee formed for limited time and specific purpose
25. Experience and Interest: Please briefly explain why you are interested in serving. Indicate past experience you have had in serving on boards and committees related to municipal government or the specific board you are interested in serving.*
27. Upload a current resume (optional)
29. Upload supplemental documents (optional)
31. Optional Information

    The information requested below would help the town obtain a well-balanced cross-section of interest and community representation.

    1. Male
    2. Female
    3. African-American
    4. Caucasian
    5. Latino
    6. Other
33. 
    If I Am Selected To Serve On The Board(s), I Will Participate.
    
    
35. Date*
37. Signature*
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit Submit and Print

* indicates a required field