Committee Application

If you are interested in serving as a member of an advisory group please complete this form; attach additional sheets if necessary. You may be called for an interview and you may wish to attend a meeting of the advisory group if you have not yet done so.
Date of Applicationfield type date
What committee are you applying for?*field type drop-down
First Namefield type single line
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Last Namefield type single line
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Street Address (residence)field type single line
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Cityfield type single line
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Statefield type single line
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Zipfield type single line
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Home Telephone Numberfield type single line
999-999-9999
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Mobile Telephone Numberfield type single line
999-999-9999
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Email addressfield type email
Length of residence in Town/Village of Lansing - Years(?)field type single line
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Monthsfield type single line
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Occupation(s)
Occupationfield type single line Name of Businessfield type single line Location of Businessfield type single line
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Education
Schoolfield type single line Degree(s)field type single line Specialitiesfield type single line
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Why are you interested in this position?field type multi line
What particular strengths would you bring to this position?field type multi line
Experience and community affiliationsfield type multi line
Recommended by(?)field type multi line
References
Namefield type single line Addressfield type single line Telephone Numberfield type single line
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Additional Documentation?field type file upload
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Signature of Applicantfield type signature
Instance IDfield type single line
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Submission IDfield type single line
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Committee Application

Occupation(s)

Education

References