CHDA Applicant Information Collection Form

CHDA Board Members Application

This application data will be collected by the Executive Director of the Colorado Horse Development Authority. All applications will be reviewed by the CHDA Executive Committee and then forward onto the Colorado Ag Commissioner for approval. This application will be electronically forwarded to the Executive Director through this process by clicking on the "Submit Form" at the end to the application.
Thank you for your interest in serving on a Board or Committee for the State of Colorado. Complete the following application to be considered for a Board or Commission.
Applicant Information

All information is required
Full Name:

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender
Social Security Number
Driver License Number
Ethnicity
Phone:

Area CodePhone Number
Cell Phone:

Area CodePhone Number
E-mail:
Upload Resume Here

Browse Files

Cancelof
Upload Proof of Residence and Citizenship

Browse Files
Drivers License, Birth certificate, etc Cancelof
District and Voter Information

Must be completed.
County
Congressional District
Senate District
House District
Are you a registered Voter?
Party Affiliation
Must be completed
Applicant Qualifications and Employment

Must be completed in full
Present Employer
Business Name
Present Title
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone#

Area CodePhone Number
Equine Affiliations and Organizational Memberships along with Offices Held
Indicate Past or Present - If this information is in the attached resume there, is no need to complete. Indicate by entering the words; See Resume,in the space provided. Information not associated with equine organizations and offices may be recorded here as well.
Special Skills and Qualifications
Volunteer Activities
Industry Segment
Are you from Western Slope?
Education Information

If Education Information is in the attached resume do not complete this section. Make sure your resume is uploaded in the "Applicant Information" section above.
High School Education

High School Name

Location

Major Course StudyYear Graduated

No. Years Attended
College 1 Education

School Name

Location

Major Course StudyYear Graduated

Degree
College 2 Education

School Name

Location

Major Course StudyYear Graduated

Degree
Graduate School

School Name

Location

Major Course StudyYear Graduated

Degree
References

Three (3) References Required, Not related to you, who you have known for at least one year
Reference #1
Reference Name

First NameLast Name
Reference Phone

Area CodePhone Number
Reference Address
Reference #2
Reference Name

First NameLast Name
Reference Phone

Area CodePhone Number
Reference Address
Reference #3
Reference Name

First NameLast Name
Reference Phone

Area CodePhone Number
Reference Address
Additional Questions

Answers to these Questions are required
1. Have you ever been a party to or the subject of or otherwise involved in any legal proceeding that might adversely affect your qualifications to serve on this board or commission? Is there anything in your background that might be an embarrassment to the Governor/Commissioner or you if it were to become public?

(This language is taken directly from the https://www.colorado.gov/governor/boards-commissions-application website.)
Response to #1
2. If appointed you are expected to attend fully to the duties of the position. How much time are you capable of committing?

(This language is taken directly from the https://www.colorado.gov/governor/boards-commissions-application website.)
Response to #2
3. Please explain why you wish to serve on a board or commission.

(This language is taken directly from the https://www.colorado.gov/governor/boards-commissions-application website.)
Response to #3
4. I understand that the Colorado Open Records Act may require that certain information contained in this application be available for inspection by the general public.

(This language is taken directly from the https://www.colorado.gov/governor/boards-commissions-application website.)
Response to #4
Electronic Signature
Full Name and Date
Should be Empty:

CHDA Board Members Application

Thank you for your interest in serving on a Board or Committee for the State of Colorado. Complete the following application to be considered for a Board or Commission.

Applicant Information

District and Voter Information

Applicant Qualifications and Employment

Education Information

References

Reference #1

Reference #2

Reference #3

Additional Questions

2. If appointed you are expected to attend fully to the duties of the position. How much time are you capable of committing?

3. Please explain why you wish to serve on a board or commission.

4. I understand that the Colorado Open Records Act may require that certain information contained in this application be available for inspection by the general public.

Electronic Signature