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2. Personal Information
4. Title
   -- Select One --Mrs.Mr.Ms.Dr.Rev.
5. First Name*
6. Last Name*
8. Preferred mailing address*

   1. Home

   1. Business
10. Home Address*
12. City*
13. State*
14. Zip*
16. Business Address*
18. City*
19. State*
20. Zip*
22. Home Phone Number*
23. Business Phone Number*
25. Email Address*
27. Employer*
28. Position*
30. Previous employers and positions
32. Do you live in the Springfield City Limits*

    1. Yes

    1. No
33. Length of Residency in Springfield City Limits*
35. Special qualifications
37. Educational background
39. Are you currently serving on other Boards, Commissions, or Task Forces*

    1. Yes

    1. No
41. If yes, which*
43. Have you served on a Board, Commission, or Task Force before?*

    1. Yes

    1. No
45. If yes, which*
47. Community activities and offices held
49. References
51. Resume
    You may also provide a resume.
53. Volunteer Boards and Commissions*

    Select the board(s) and/or commission(s) on which you would like to serve.

    1. Airport Board
    2. Animal Issues Task Force
    3. Art Museum Board
    4. Board of Public Utilities
    5. Springfield-Greene County Park Board
    6. Administrative Review Committee
    7. Citizens Advisory Committee for Comm. Development
    8. Citizens' Sales Tax Oversight Committee
    9. Landmarks Board
    10. Mayor's Commission for Children
    11. Mayor's Commission on Human Rights
    12. Personnel Board
    13. Planning & Zoning Commission
    14. Police & Firefighters' Retirement System Board
    15. Police Civilian Review Board

    1. Springfield-Greene County Environmental Advisory
    2. Traffic Advisory Board
    3. Tree City USA Citizen Advisory Committee
    4. Center City Development Corporation
    5. Industrial Development Authority
    6. Public Building Corporation
    7. Springfield Convention & Visitors Bureau, Inc.
    8. Board of Adjustment
    9. Building Trades Examination & Certification Board
    10. Board of Equalization
    11. Land Clearance for Redevelopment Authority
    12. Public Housing Authority
    13. Springfield-Greene County Public Library Board
    14. University of Missouri Extension Council
    15. Enhanced Enterprise Zone Board
55. If Board of Public Utilities, select your political affiliation*

    1. Democrat

    1. Republican

    1. Independent
Leave This Blank:


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

    This field is not part of the form submission.

58. Submit Submit and Print

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