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2. Select the Board, Commission, or Committee applying for*
   -- Select One --Select OnePlanning & Zoning CommissionBoard of AdjustmentsEconomic Development CorporationTown CouncilP&Z, BoA or EDCCouncil, P&Z, BoA or EDC
4. Personal Information
6. First Name*
7. Last Name*
9. Sex:*

   1. Male
   2. Female
10. Voter Registration Number*

    If you do not know your Denton County Voter Registration Number, you can submit your Date of Birth in the following format: "MM/DD/YYYY"

12. Home or Mobile Phone Number*
13. Business Phone Number
14. Email Address
18. Residency Information
20. Address*
22. City*
23. State*
24. Zip*
26. Length of Residency in Providence Village*
30. Occupational Information
32. Occupation*
33. Employer*
35. Address
37. City*
38. State*
39. Zip*
43. Education and Hobbies
45. High School
47. College
49. Trade or Business School
51. Hobbies
55. Organization Membership Information
57. Do you currently serving on other Boards, Commissions, or Committees?*

    1. Yes

    1. No
59. If yes, which
61. Have you served on a Board, Commission, or Committee before?*

    1. Yes

    1. No
63. If yes, which
65. Please list organization memberships and positions held
69. Please List Areas of Special Interest
71. Please Enter Basic Resume Information Below
73. How do you believe your experience may be beneficial to the residents of Providence Village?
75. Please list any business or personal relationships with the Town that might create a conflict of interest or impact your ability to serve:
79. Statement of Intent*

    I am aware of the requirements of the Town regarding conflicts of interest of appointees to the Town of Providence Village Council, Boards and Commissions. I am aware of meeting dates and times of the council, board and/or commission for which I have applied and that members are expected to attend regularly scheduled meetings. If appointed, I agree to serve on the council, board and/or commission for which I have applied. Applications will remain on file for one year from date of receipt. I affirm that the above information is true and correct.

    1. I agree.
81. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
83. Electronic Signature

85. Please Note: In compliance with Chapter 552, Vernon’s Texas Codes Annotated, (Open Records Law) information provided on this application may be available to the public upon request.

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

    This field is not part of the form submission.

89. Submit Submit and Print

* indicates a required field