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Application to Serve on City Board, Commission or Committee

2. Name

4. Address

6. Contact Number

8. Email

10. Please indicate which Board, Commission or Committee you are interested in serving on:

12. I would like to serve on:
    -- Select One --Board of AdjustmentBoard of AppealsCIP CommitteeCivil Rights CommissionCivil Service CommissionLibrary Board of TrusteesParks & Recreation CommissionPlanning & Zoning CommissionPublic Art CommitteeTemporary Appointment to City CouncilTree BoardUrbandale Sanitary Sewer DistrictUrbandale/Windsor Heights Sanitary Sewer DistrictWater Utility Board of Trustees

    Please select the Board, Commission or Committee you would like to serve on.

14. Please list your qualifications:

    List your educational and professional experience, and/or your biographical information that would help you succeed as a member of the Board, Commission or Committee

16. Gender & Transgender Status
    The City does not discriminate on the basis of gender identity or expression, and strives to comply with the State of Iowa’s gender balance statute. In order to ensure our Boards, Commissions and Committees are free of gender partiality, and to meet State of Iowa gender balance guidelines, please check one of the following:

    The City does not discriminate on the basis of gender identity or expression, and strives to comply with the State of Iowa’s gender balance statute. In order to ensure our Boards, Commissions and Committees are free of gender partiality, and to meet State of Iowa gender balance guidelines, please check one of the following:

17. Selection

    1. Female
    2. Male
    3. Non-binary/third gender

    1. Prefer to self-describe
    2. Prefer not to say

19. Thank You!
    Your completed form will be sent to the City Clerk. The Clerk's office can be contacted at 515-278-3900.

    Your completed form will be sent to the City Clerk. The Clerk's office can be contacted at 515-278-3900.

20. Next Steps.
    The Mayor reviews applications of interest when a Board, Commission or Committee has an opening. This could be either due to a member's term expiring or due to a member stepping down early.

    The Mayor reviews applications of interest when a Board, Commission or Committee has an opening. This could be either due to a member's term expiring or due to a member stepping down early.

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

    This field is not part of the form submission.

24. Submit

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