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Names of board, committee, authority, etc., in which you are interested. Please list in order of priority:

Name:

Primary Phone:

Address

Street Address:

City:

State:

Zip Code:

Live within City Limits:

Occupation:

Place of Employment:

Business Phone:

Email Address:

Education:

Business and Civic Experience:

Areas of Expertise, Interest, Skills:

Why do you want to serve?

Equal Opportunity Information

County government policy prohibits discrimination based on race, sex, creed, national origin, age, or handicap. The information requested will in no way affect the interest you have express in serving Catawba County. Its sole use will be to see how well our appointment efforts are reaching all segments of the population.

Race:

Sex:

Age:

Acknowledgement

I agree to attend an orientation session to be held within one year after appointment to a board. The orientation session will be held during the daytime hours and will last approximately two hours.

Please sign by typing your name below:

Date:

Full Name:

The Catawba County Board of Commissioners sincerely appreciates the interest of all citizens in serving their county. For more information on the responsibilities of various boards, you may contact the County Clerk's Office at (828) 465-8990. This form will remain active until two years after date received.