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Citizen Application for Appointment to a City Committee, Commission, or Board

2. Thank you for your interest in serving on a City of Monona committee. Please provide the information listed below. All information on this form is public record.

   Thank you for your interest in serving on a City of Monona committee. Please provide the information listed below. All information on this form is public record.

4. Name*

6. Home Address*

8. Email(s)*

10. Phone*

11. Alternate Phone

13. Employer

14. Occupation

16. Please check all committees on which you're interested in serving.*

    1. Board of Review
    2. Community Media Committee
    3. Community Development Authority
    4. Distinguished Service Award Committee
    5. Facilities Committee
    6. Landmarks Commission
    7. License Review Committee
    8. Library Board of Trustees
    9. Transit Commission

    1. Parks & Recreation Board
    2. Plan Commission
    3. Police & Fire Commission
    4. Public Safety Committee
    5. Public Works Committee
    6. Senior Citizens' Commission
    7. Sustainability Committee
    8. Tourism Commission
    9. Zoning Board of Appeals
18. What education or special training do you have which you feel particularly relates to the committee(s) in which you're interested?

20. What work experience or other experience do you have which will be beneficial in carrying out the responsibilities of this committee(s)?

22. The City of Monona is committed to ensuring that the City’s boards, committees, and commissions represent a cross section of the Monona community. As such, please consider sharing as much personal information about yourself as you’re comfortable sharing. For instance, your age, sex/gender, race/ethnicity, how long you’ve lived in Monona, etc. Please note that you are not required to answer this question.

Leave This Blank:


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

    This field is not part of the form submission.

26. Submit

* indicates a required field