Committee Membership Application

Committee Membership Application

ISICS Committees normally meet at least once per month virtually. Committee information can be found at https://isicsb.iowa.gov. If you have any questions please contact the SWIC at nichols@dps.state.ia.us.
First Name *
Last Name *
Job Title *
Agency *
Direct Manager *
Mobile Phone
Please enter a valid phone number.
Office Phone *
Please enter a valid phone number.
Email *
example@example.com
Alternate Email (if applicable)
example@example.com
County *
Committee You Would Like to Become a Member of *
If you request to become a member of more than one ISICS Committee, please fill out additional forms and submit separately.
Please verify that you are human*
Should be Empty: