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Step One

1. Area of Interest
(Please complete a separate application for each municipal board or position on which you would like to serve.)
Board/Position:*
Is this a reappointment?
1. Yes
1. No
If yes, please indicate your current and previous board/position and term(s) of service.
2. Applicant Information
First Name*
Last Name*
Residence Address*
Mailing Address (if different)
Telephone
Cell phone
Email
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Step Two

3. Background Information
The following questions are optional and are included as an effort to insure that appointments represent all segments of the population of Madison, where reasonably possible with due consideration of board/position obligations and commitments, education, demonstrated interest, etc.
Age
Gender
Race
Ocupation/Employer
Registered Voter
1. Yes
1. No
Voting District*
You must be a resident of the City of Madison to serve on this board.
Unsure of your district? Check:
Election Distric Map
Voting District
Non-City Resident Applicants
1. I am a resident of Morgan County
Up to two non-city residents may serve on the Cemetery Stewardship Commission. These applicants must be residents of Morgan County. Please confirm.
Non-City Resident Applicants
Non-City Residents may serve on the Downtown Development Authority provided they own a downtown business. Please indicate the name of the business you own.
Non-City Resident Applicants
Non-City Residents may serve on the Corridor Design Commission provided they own a business on the Corridor. Please indicate the name of the business you own.
Non-City Resident Applicants
Non-City Residents may serve on the Public Arts Commission provided they are associated with a Madison business or nonprofit. Please indicate the business or nonprofit you are associated with.
Non-City Resident Applicants
Non-City Residents may serve as a Madison representative on the CVB Board provided they are associated with a Madison business. Please indicate the business you are associated with.
4. Education/Experience
What professional or community experience do you have related to this board/position?
(Although some boards/positions have requisite areas of education/experience, qualified layperson(s) are also eligible for appointment.)
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Step Three

5. Contributions/Intentions
What do you feel will be your biggest contribution if appointed to this board/position?
6. Other Comments or Information
Other Comments
I have been informed and understand the obligations and commitments required by this board/position. If appointed by the Mayor and Council of the City of Madison, I agree to serve and faithfully execute the obligations and commitments of said board/position for the duration of the term of appointment. In all respects, I will uphold the ordinances and policies of the City of Madison in a professional and courteous manner and fully divulge any and all potential conflicts of interest. I hereby certify that the information I am submitting is complete and accurate. I understand that checking "Affirm" below acts as my signature on this form.
1. Affirm
Date
Date

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

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