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Waco
Leadership-Appointed Officials

Application for Board / Commission Service

All fields must be completed unless retired/unemployed, in which case employment-related fields are not required.

Please specify the Board/Commission on which you wish to serve (Not Required):
Name:
Home Address:
City:Zip Code:
Home Telephone:Email:
Profession:
Business Name:
Business Address:
City:Zip Code:
Business Telephone:
Cell Phone:
Preferred Mailing Address:
City:Zip Code:
Under the Texas Public Information Act, you may elect to have certain personal information withheld from public release. Please indicate if you wish to have this information withheld from a Public Information Request.
     wish to have my home address, home telephone number, personal cell phone number or personal e-mail provided as information in a public information request.
If you have been a member of a Waco board or commission before, please indicate the board or commission and approximate dates of service:
What experience do you have that may qualify you for service on a particular board or commission such as licenses, degrees and certificates? (There are a number of boards that require special qualifications such as plumbers, pilots, or electricians.)
List any civic or community endeavors in which you have been involved:
Have you ever been convicted of a crime, other than minor traffic violations?    
If yes, please explain:
I am a Youth in grade 9-12 interested in serving on a Board and Commission
(The City Council supports youth participating in Boards and Commissions as advisory members on the Boards.)
I hereby certify that the information given by me in this application is true and complete. I understand and agree that any false information or misrepresentation is sufficient grounds for disqualification. I understand and agree that all information provided in this application may be verified by the City of Waco.
Applicant Name:Date:
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