Application for Boxelder Basin Regional Stormwater Authority Board of Directors

1. Name *This question is required.

2. Mailing Address *This question is required.

Address

Address 2

City

State

Zip

3. Residence

Same as mailing address *This question is required.

Address

Address 2

City

State

Zip

4. Phone

5. Length of residence in the City of Fort Collins Growth Management Area *This question is required.

6. Current Occupation

7. Current Employer

8. Recent and/or relevant work experience (please include dates) *This question is required.

9. Recent and/or relevant Volunteer experience (please include dates) *This question is required.

10. Are you currently serving on a City or County Board? *This question is required.

Which City or County board are you serving on? *This question is required.

Why do you want to become a member of this particular Authority ? *This question is required.

11. List any abilities, skills, licenses, certification's, specialized training, or interest you have which are applicable to this Authority. *This question is required.

12. Briefly explain what you believe are the three most important issues facing this Stormwater Authority, and how do you believe this authority should address each issue? *This question is required.

#1 *This question is required.

#2 *This question is required.

#3 *This question is required.

13. Please specify any activities which might create a serious conflict of interest if you should be appointed to this board or commission.

14. By signing and submitting my application to the City of Fort Collins, I swear or affirm under penalty of perjury pursuant to the laws of the State of Colorado: That I meet the eligibility requirements of the position sought. *This question is required.

15. By signing and submitting my application to the City of Fort Collins, I swear or affirm under penalty of perjury pursuant to the laws of the State of Colorado that the information provided in this application is true and correct to the best of my knowledge. *This question is required.

16. Signature *This question is required.

Clear

Signature of