LexingtonKy.gov : Online Forms

Survey/Form Review

Boards & Commissions Interest Form

Information provided on this form will be a public record subject to free and open examination by any person under the Kentucky Open Records Act

1. Are you interested in being re-appointed to your current board or commission?

Yes

2. Name of board or commission you are interested in serving on:

3. First Name:

4. Last Name:

5. Home Street Address:

6. Home City:

7. Home State:

8. Home Zip Code:

9. Mailing Address (if different than home):

10. Home Phone Number:

11. Work Phone Number:

12. Cell Phone Number:

13. Employer:

14. Profession / Occupation:

15. Are you applying as a representative?

Yes

16. If yes, what position?

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