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2. Date*
   Date
3. First and Last Name*
5. Address*
7. City*
8. State*
9. Zip*
11. Phone Number*
12. Second Phone:*
13. Email*
15. Occupation
16. Occupation Phone Number
18. Party Affiliation*
19. Registered Voter*

    1. Yes
    2. No
21. Name of the Board You Wish to Apply For:*
    -- Select One --2024 Charter Revision CommissionAgricultural CommissionArea 25 Cable Television AdvisoryBlight Review CommitteeBoard of Assessment AppealsBuilding Code Appeals BoardCommission on AgingConservation CommissionCT Water Co. Advisory Council Enfield RepDiversity, Equity & Inclusion CommitteeEconomic Development CommissionEnfield BeautificationEnfield Culture & Arts CommissionEthics CommissionFair Rent CommissionGreater Hartford Transit DistrictHazardville Water Company Advisory Council Enfield Rep.Historic District CommissionHousing AuthorityHousing Code of Appeals BoardInland Wetlands and Watercourses AgencyJFK School Renovation Building CommitteeJoint Facilities CommitteeLibrary Board of TrusteesLoan Review CommitteeNo Central District Health Dept. Board of Directors Enfield RepNo Central Regional Mental Health Board Enfield RepPatriot Award CommitteePK-5 School Modernization Referendum CommitteePlanning & Zoning CommissionPrison Town Liaison Committee Public Safety Complex Building CommitteeRiver Valley CT Central Regional Tourism DistrictSenior Tax Relief CommitteeTax Incremental Financing AdvisoryZoning Board of Appeals
22. Appointment

    1. New Appointment
    2. Reappointment
24. Please outline your qualifications and how you feel you would contribute to the committee or commission:
26. Have you ever served on a Board, Commission or Agency in Enfield or elsewhere?

    1. Yes
    2. No
28. If so, please state name of board, commission or agency and time server:
30. If this is a reappointment, please list the number of meetings attended during the last 12 months:
32. If the committee or commission which you requested has no more vacancies, would you consider appointment to another committee or commission?

    1. Yes
    2. No
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit Submit and Print

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