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Application for City Boards, Commissions, and Committees

  1. Registered Voter in the City of Dickinson?:*
  2. Employment
  3. Education and Organizational Memberships
  4. Name of Board, Commission, or Committee you are applying for:*
  5. I hereby certify that the above statements are true and correct to the best of my knowledge. I understand that a false statement may disqualify me for consideration to serve on a City Board, Commission or Committee. *
  6. THIS APPLICATION IS GOOD FOR AND WILL BE RETAINED FOR TWO (2) YEARS IN ACCORDANCE WITH THE CITY OF DICKINSON’S RECORDS RETENTION POLICY. IN ORDER TO BE CONSIDERED FOR APPOINTMENT, AN APPLICANT MUST SUBMIT A NEW APPLICATION EVERY TWO (2) YEARS.
  7. Leave This Blank:

  8. This field is not part of the form submission.