Board Application Form

Board of Directors Candidate Online Application

Candidate information
Fill out your personal information as much as you can (most questions are required).
Name*
First Last
Home Address*
Street Address Address Line 2 City State ZIP Code
Primary Phone
Enter the number you wish to be contacted at for DBCC Board related communications.
Email address*
Enter the email address you wish to be contacted at for DBCC Board related communications.
Enter Email Confirm Email
How did you find out about the Dayton's Bluff Community Council?*
Candidate type*
If you live in the neighborhood and are applying as a resident, choose "Resident." If you own a business in the neighborhood, choose "Business." If you are a high school or university student and are applying for a student seat, choose "Student." If you are interested in representing an "Educational Institution" or "Faith Institution" please select accordingly.
- Business
- Educational Institution
- Faith Institution
- Resident
- Student
Business name
Fill out if you are applying as the owner or employee of a business located in Dayton's Bluff.
Business Address
Enter the address for the business named above.

Street Address Address Line 2 City State ZIP Code
Employment*
Enter the name of your employer. If you work for yourself, put your DBA or "self."
Job title*
District you are running for (check one)*
- Sub-District A
- Sub-District B
- Sub-District C
- Sub-District D
- At-Large
- Student At-Large
- Unsure
Personal background (3-5 sentences)*
(education, length of residence, other memberships -- whatever you think is important about yourself)
Goals and accomplishments (3-5 sentences)*
(describe what you would like to achieve while serving on the board)
What challenges do you see facing the community?*
(3-5 sentences)
Filing certification
Please fill out and sign the following filing certification form.
(Name statement) I,*
(type full name above) hereby file for a Board of Directors position on the Dayton's Bluff District 4 Community Council and request that my name appears on the ballot.
Signature*
(use your mouse, trackpad, tablet or phone screen to draw your signature in support of the above statement)

Board of Directors Candidate Online Application

Candidate information

Filing certification

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