Board Bank Application

Board Bank Application
Full Name: *
Mr., Mrs., Miss, Rank: *
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email Address:
example@example.com
Home Phone:
Please enter a valid phone number.
Business Phone:
Please enter a valid phone number.
Cell Phone:
Please enter a valid phone number.
Fax Number:
Please enter a valid phone number.
Profession / Vocation: *
Current Employer: *
Which Board(s)/Commission(s) do you wish to serve on?: *

Agency on Aging Alcohol Safety Action Program Arts Commission of York County Arts Commission of Williamsburg Beautification Committee Board of Building Code Appeals Board of Equalization Board of Zoning & Subdivision Appeals Chesapeake Bay Board Colonial Behavioral Health Colonial Juvenile Services Commission Community Criminal Justice Board Comprehensive Plan Steering Committee Community Services Grants Advisory Committee Economic Development Authority Employee Grievance Panel Historical Committee Historical Triangle Bicycle Advisory Committee Historic Yorktown Design Committee Library Board Local Finance Board Marquis Community Development Authority Parks & Recreation Advisory Board Planning Commission Senior Center Board Social Services Advisory Board Virginia Peninsula Community College Board Wetlands Board Williamsburg Regional Library Board of Trustees Youth Commission
Are you currently serving on a Board/Commission? *

Yes No
Please list the Boards/Commissions you are currently serving on:
(If Applicable)
Other interests:
Select the highest level of education completed: *

High School Associate Degree Bachelor's Degree Master's Degree Other
Job experience: *
Civic or service organization experience: *
Have you previously served as a member of a York County Board or Commission? *

Yes No
If so, which Board or Commission?
Are you a registered voter? *

Yes No
What district do you live in? *
Should be Empty: