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Application for Boards, Commissions and Committees

  1. Personal Information

  2. Title:*

  3. Residency Information: (Please note that only Southlake residents who are registered voters are eligible for appointment.)

  4. Are you a resident of Southlake?*

  5. Are you a registered voter?*

  6. Do you, your spouse or your employer have any financial interest, directly or indirectly, in matters that might come before the Board and Commission to which you seek appointment?

  7. Do you, your spouse or your employer have any financial interest, directly or indirectly, in the sale to the City of any land, materials, supplies or service?

  8. Please indicate your areas of interest (up to five).

  9. Background

  10. Education

  11. Reasons for seeking appointment:

    Please attach a brief narrative outlining your interest and qualifications for seeking appointment. You may also add a resume or additional information.

  12. Completed forms may be delivered to the City Secretary's Office, Town Hall, 1400 Main Street, Suite 270, Southlake, Texas 76092, faxed (817) 748-8270, or e-mailed Applications are kept on file for a period of one (1) year. After that time it will be necessary to reapply and update the information herein if you wish to be considered for appointment.

  13. By signing below, you certify that all information on this form is represented accurately. The applicant further authorizes the City Council, or its designee, to verify any information. The applicant agrees to release and hold harmless the City from all claims incident to the verification of information contained herein. All information provided is considered public pursuant to the Texas Public Information Act.

  14. Signature:

  15. Leave This Blank:

  16. This field is not part of the form submission.