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Advisory Board Chair Report (Complete One Per Applicant)

2. Advisory Board Name:*

3. Chair Name*

5. Applicant First Name:*

6. Applicant Last Name:

8. 1. Has the applicant previously served on this or another advisory board?*

   1. Yes
   2. No

9. 2. If yes, how many total years have they served?

   This should be available on the application or by asking the applicant.

11. 3. Is the applicant already serving on this advisory board and seeking reappointment to their second, full term?

    1. Yes (Skip to Last Question)
    2. No

12. 4. Is the applicant already serving on this advisory board and completed their two full terms?

    1. Yes
    2. No

14. 5. Is the applicant applying for a special or expert seat on the advisory board?*

    1. Yes
    2. No

15. 6. If yes, which seat?

17. 7. Did the applicant attend an advisory board meeting?*

    1. Yes
    2. No

18. 8. If applicant did not attend an advisory board meeting, did you contact them via phone or email?

    1. Yes
    2. No

20. 9. Applicant has demonstrated a clear understanding of the time commitment, roles, and responsibilities of serving on the advisory board:

    1. Yes
    2. No

21. 10. If no, briefly explain:

23. 11. In addition to your comments above, please check other qualities that the applicant offers that would help the Advisory Board meet its goals for community representation. Please note that candidates who do not meet any of these qualities are still eligible for appointment. Please communicate any urgent needs and priorities for Advisory Board composition to your Town Council liaison.

    1. Diversity
    2. Occupation, Experience, or Special Skills
    3. Other

25. If other, please explain:

Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit Submit and Print

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