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Application for Appointment to County Committees, Boards, Commissions and Task Forces

Application for appointment to*
First Name*	Last Name*	Middle Initial
Street		City
State	Zip	Yes
Home Phone	Work Phone	Mobile Phone
Email Address
Commissioner District in which you reside		To locate Commissioner District: Go to Interactive Mapping tool Enter address in search field; click Find Select "Commissioner" from menu
Availability to Attend Meetings Anytime Mornings Afternoons Evenings
Background / Experience
Volunteer Work / Community Activities
Other County Boards/Commissions/Committees on which you have served
Education
Other Experience or information you would like to have considered in making this appointment
Do you or any member of your immediate family work for Stearns County? No Yes
Are you an elected official? No Yes
Please answer this question only if applying for appointment to an Adults & Families board, commission, committee, or task force. Have you or has anyone in your immediate family, been a recipient of Human Services at anytime in the past? N/A No Yes
Please answer this question only if applying for appointment to the Planning Commission. Have you received, during the last two years prior to application, any substantial portion of your income from business operations involving the development of land within the County for urban and urban-related purposes? N/A No Yes
Upload any additional information relative to this application File Size: 10000KB Maximum File Types: .doc .docx .pdf
Information provided by you on this application will be used by Stearns County to determine an appointment to a Stearns County board, commission, committee, or task force. You are not obligated to provide the information but choosing not to may prevent an appointment.
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