Committee Application Form

2. City of Middleton Board/Commission/Committee Application Form

4. Date*

6. What board/commission/committee(s) are you applying for?*

   See listing on board, commission, and committee home page

8. Personal Information

10. Name*

12. Address, City, State Zip*

14. Cell Phone Number*

15. Home Phone Number

17. Email address*

19. Occupation*

21. Employer Name*

22. Work Phone Number*

24. Residency Information

26. Do you currently reside in the City of Middleton?*

    1. Yes
    2. No

27. If yes, for how long?

29. Education and Personal Interests

31. Education

33. Personal Interests

35. Organization Membership Information

37. Are you currently serving on other Boards, Commissions, or Committees?*

    1. Yes
    2. No

39. If yes, which

41. Have you served on a Board, Commission, or Committee before?*

    1. Yes
    2. No

43. If yes, which

45. Community Involvement

47. Qualifications for Specified Committee(s) (please attach resume or bio)

49. Resume upload (not required)

51. Additional Information

53. Signature and Attestation*

    Please type your name to attest the information you are submitting is true, accurate, and complete to the best of your knowledge.

55. Please click the link below to complete a voluntary self-identification form.
    Self-Identification Form

Leave This Blank:


57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit Submit and Print

* indicates a required field