BOARD/COMMISSION APPLICATION

Name :___________________________________________________________________________________

Residence Address:__________________________________________________________________________________

Mailing Address :__________________________________________________________________________________

Telephone :(Work) ___________________________                        (Home) _________________________

Date Applied : ______________________    

Are you a registered voter?      Yes _________No __________

                          Time Available (circle one)

____________________________________________________           2   5  10  20  30 hours per month(Board/Commission)                                                                                      

VOLUNTARY INFORMATION

____ Male ____ Female

Ethnic Group (Check only one):

Attach a resumé or outline of your education, work, volunteer experience and other interests. List three references.

Return to: Michael Johnson
Office of the Mayor
Boards and Commissions
P.O. Box 196650
Anchorage, Alaska 99519-6650
Email:  johnsonmf@muni.org