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2. Board or Committee Application Form
4. First Name
5. Last Name
7. Address
9. City
10. State
11. Zip Code
13. Phone Number
14. Email Address
16. Board or Committee(s) applying for:
18. Have you served on this Board or Committee Previously?*

    1. YES
    2. NO
22. Experience
24. In lieu of answering the next two questions, please feel free to attach a résumé.
26. Professional/Business/Volunteer affiliations:
28. Membership in other organizations:
32. Additional Information
34. Please outline what skills you would bring to the board:

38. The Jasper County Supervisors encourage all people without regard to age, sex, ethnicity, or place of residence in the county to apply and make every effort to comply with Iowa Code Section 69.16A providing for gender balance on local boards commissions, committees, and councils.

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

    This field is not part of the form submission.

42. Submit

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