Boards & Commissions Application

City of Manistique

Boards & Commissions Application
Thank you for your expression of interest in serving this community by volunteering for appointment to a board or
commission. Please provide the requested information in addition to any other information you think appropriate for the
Mayor and City Council to consider. Please plan on attending the Council meeting at which this matter will be
considered. The public notice for this vacancy included that date.

Application Information

Full Name(required)

Date (required)

Address (Street Address, Apartment/Unit #)(required)

Address Cont. (City, State, ZIP Code)(required)

Phone(required)

Email(required)

How long have you been a resident ofManistique?(required)

And how long? (This corresponds with the above question if not applicable put N/A)(required)

Interests and Experiences:

Please list your Interests and Experiences that you would like to share with us(required)

Disclosure of Potential Conflict of Interest:

Please list any possible conflicts of interest, including the name of each organization with a description of your affiliation.If you have no potential conflicts of interest, please simply state “none”.(required)

Disclaimer and Signature:

If this application leads to assignment, I understand that false or misleading information in my application or
interview may result in my release from the board/commission appointment.

Signature(required)

Date (required)