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2. As a member of a board or commission, you will be expected to attend at least 75% of the meetings. Please note the bylaws of some boards and commission limit the number of terms served. This application is a notification of your interest to be considered by the Board of Supervisors when a vacancy occurs.
4. Select the Board, Commission, or Committee applying for*
   -- Select One --Select OneAFD Advisory CommitteeAirport Advisory CommissionBoard of Building Code AppealsClean County CommitteeEconomic Development AuthorityHistoric CommissionParks & Recreation Advisory CommissionPlanning CommissionPDR Advisory CommitteeRoad Viewers BoardSocial Services Advisory BoardTransportation Safety CommissionWetlands BoardZoning Appeals BoardHeritage Library Board of TrusteesHenrico Area Mental Health & Developmental Services BoardMPO Citizens Transportation Advisory CommitteeThrive Virginia
6. Personal Information
8. First Name*
9. Last Name*
11. Sex:*

    1. Male
    2. Female
13. Address1*
15. Address2
17. City*
18. State*
19. Zip*
21. Home Phone Number*
23. Mobile Phone Number*
25. Business Phone Number*
27. Occupation*
29. Email Address
31. Residency Information
33. Length of Residency in New Kent *
35. Are you a registered voter*

    1. Yes
    2. No
37. Have you ever been convicted of a felony?

    1. Yes
    2. No
39. Are you a NKU graduate?

    1. Yes
    2. No
41. Are you currently serving on other Boards, Commissions, or Committees?*

    1. Yes
    2. No
43. Have you served on a Board, Commission, or Committee before?*

    1. Yes
    2. No
45. If yes, which
47. Please list organization memberships and positions held
49. Please identify any talent, interest, skill, experience or educational prepration which might be helpful to a Board or CommissionList Areas of Special Interest
51. Please Enter Any Other Basic Resume Information Below
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit Submit and Print

* indicates a required field