Application for Appointment to the CPMT or FAPT

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Are you a City Resident?*

YesNo

If yes, how long

Home Phone*

Please enter a valid phone number.

Work Phone, if different

Please enter a valid phone number.

Occupation*

Committee I'd like to be appointed to:*

CPMTFAPT

Position I would like to serve as:*

Parent RepresentativePrivate Provider Representative

Current or prior elected or appointed positions held

Memberships and activities*

How did you hear about the vacancy?*

Social mediaNews sourceWebsiteOther

If Private Provider Representative, please complete the following:

Business Name

Business Address

Type of Business

Number of years in existence

We appreciate our Private Providers and seek to maintain productive working relationships with each of them. Our process for applying to become a member of our CPMT or FAPT, when there is a vacancy, requires the following:

Completion of the Application for appointment to CPMT or FAPT (please use additional pages, if needed, to fully respond to any of the questions).
A cover letter detailing your interest in serving as a Private Provider Representative and why you feel qualified to undertake this role.
A copy of your resume.

Resume

Cover Letter or Letter of Interest

Please verify that you are human*