2. First Name*
3. Last Name*
4. Date*
   Date

   Application Date

6. Address*
8. City*
9. State*
10. Zip Code*
12. Phone Number*
13. Email Address*
15. I am interested in serving on the following Commission*

    1. Arts Commission
    2. Block Grant Advisory Committee
    3. Disability Board
    4. Historic Preservation Commission

    1. Kennewick Housing Authority
    2. Parks & Recreation Commission
    3. Planning Commission
17. Occupational Status and Background*
19. What unique qualities or attitude will you bring to this position?*
21. Community Related Activities/Organizational Affiliations*
23. Volunteer Experience*
25. What interests you about this Board/Commission?*
27. Experiences related to position applied for*
29. Why are you seeking appointment?*
31. To the best of your knowledge, would any conflict of interest be created as a result of your appointment?*
33. What makes you a good choice for this Board/Commission?*
35. Personal References*
37. Disclaimer and Electronic Signature Agreement*

    By checking the "I Agree" box below, you agree and acknowledge that 1) you understand that this application and supporting documents may be made available for public inspection, including inspection by member of the press and media; 2) your application will not be signed in the sense of a traditional paper document; 3) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 4) you may still be required to provide a traditional signature at a later date.

    1. I Agree
39. Electronic Signature
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41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

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