Board/Committee Application 

2. Name*
3. Email Address*
5. Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
12. Fax Number
14. Board/Committee *
    -- Select One --Board of Equalization of Review Board of Health Dangerous Dog Board EDC Board of Directors Foothill Regional Airport Authority Juvenile Crime Prevention Council (JCPC) Voluntary Agricultural District Library Board of Trustees Local Emergency Planning Committee (LEPC) Planning Board/Board of Adjustment Board of Social Services Adult Care Home Community Advisory Committee

    Select the board or committee you are applying to.

15. Are you requesting reappointment to this board/committee? *

    1. Yes
    2. No
17. Please list all county boards/committees you are currently serving on:*
19. Why do you want to serve on this board/committee? *

21. For the purpose of diversity and balance on Caldwell County's boards/committees, please complete the following: 

23. Race: *
24. Sex: *
26. I am a resident of the City/Town of: *
27. I have been a resident of Caldwell County for _______ years: *
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field