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5 <br />APPLICATION FOR MEMBERSHIP ON TOWN OF CHAPEL HILL <br />ADVISORYBOARD, COMMISSION, COMMITTEE OR TASK FORCE <br />This application requests some general information based on your interest in applying for a position on a <br />Chapel Hill Town Advisory Board, Commission, Committee or Task Force. Please type or use dark ink. <br />Applicant's Legal Name: <br />Home Address: <br />Home Phone: <br />FAX Number: <br />Email Address: <br />Date of Application: / / <br />In order to consider this application and provide some balance to the various boards, this personal <br />information is required: <br />Male: ^ Female: ^ Ethnicity: (African American, Asian, Caucasian, Hispanic, Native American) <br />Date of Birth: / / Occupation: <br />Residency within the Town limits is required for membership on most Council advisory boards and <br />commissions. Memberships of committees and task forces may be composed of up to forty percent of non- <br />Town residents. <br />Do you reside within the Town Limits of Chapel Hill: Yes ^' No ^! <br />Length of residence in Chapel Hill: <br />Years Months <br />How did you find out about this Board? (please circle or underline one) <br />Newspaper, Email, Friend, TV, Internet, Current Member, Brochure, Bus Poster, Radio, Magazine, Speaker at <br />Event, Other <br />The Council encourages you to visit a meeting of the group that you are interested in serving on. <br />Please indicate your preferences by number (first choice being "1") and choose no more than three, along <br />with category, if applicable. <br />COUNCIL ADVISORY BOARDS AND COMMISSIONS <br />Bicycle and Pedestrian Advisory Board Library Board of Trustees <br />Board of Adjustment <br />Cemeteries Advisory Board <br />Chapel Hill Downtown Partnership <br />Chapel Hill Public Arts Commission <br />Community Design Commission <br />Community Policing Advisory Committee <br />Greenways Commission <br />Historic District Commission <br />Human Services Advisory Board <br />Personnel Appeals Committee <br />Planning Board <br />Public Housing Program Advisory Board <br />Stormwater Management UtiliTy Advisory Board <br />Sustainability Committee <br />Transportation Board <br />OTHER COUNCIL COMMITTEES AND TASK FORCES <br />(Please Specify): <br />Category(s) if applicable: <br />Street Address, City, Zip Code <br />Business/Other Phone: <br />Orange Water & Sewer Authority (OWASA) <br />Parks & Recreation Commission <br />- over - <br />- \\chfs\Clerk\Boards_Commissions_Committees_etc\Forms\Applications\DO NOT SEND Application Form 3-2011 - Copy.doc Comm & <br />Public Affairs/3-2010 <br />