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2. First Name*
3. Last Name*
5. Email Address*
6. Phone*
8. Home Address*
10. City*
11. State*
12. Zip Code*
14. Country
16. Mailing Address
18. City
19. State
20. Zip Code
22. Country
24. Type of Appointment*

    1. New
    2. Reappointment
25. Board Applying for*

    1. Affordable Housing Committee
    2. Aquidneck Island Planning Commission
    3. Beach Commission
    4. Board of Canvassers
    5. Citizens Memorial Committee
    6. Conservation Commission
    7. Discover Newport
    8. Economic Development Advisory Committee (MEDAC)
    9. Juvenile Hearing Board
    10. Library Board of Trustees
    11. Middletown Bicycle and Pedestrian Advisory Committee
    12. Middletown Center Citizens Advisory Committee

    1. Middletown Outreach Sub-Committee
    2. Middletown Prevention Coalition
    3. Open Space and Fields Committee
    4. Pension Trust Fund Committee
    5. Personnel Board
    6. Personnel Review Board
    7. Planning Board
    8. Roads and Utilities Advisory Committee
    9. Senior Citizens Board of Directors
    10. Tax Assessment Review Board
    11. Tree Commission
    12. Zoning Board of Review
27. Employer*
28. Length of Employment*
30. If Less Than 2 Years, Previous Employer
32. Educational Background*
34. Work Experience Related to Agency Applying for*
36. Prior Term Attendance*
38. Explanation of Interest in This Commission*
40. How Did You Hear About This Position?

    1. Online
    2. Social Media
    3. Word Of Mouth
    4. Newspaper
    5. Other
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42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

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