2. Name*

   Please type your full name. 

3. Email*
5. Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
12. Please Check all Boards and Commissions on which you would be willing to serve:*

    1. Board of Public Utilities
    2. Board of Review
    3. Coldwater Public Library Advisory
    4. Downtown Development Authority
    5. Historic District Commission
    6. Housing Commission
    7. Planning Commission
    8. Recreation Board
    9. Economic Development Corporation
    10. Local Development Finance Authority & Brownfield Redevelopment Authority Boards
    11. Construction Board of Appeals
    12. Property Maintenance Code Board of Appeals
    13. Zoning Board of Appeals
14. Are you at least 21 years of age?*

    1. Yes, I am at least 21 years of age.
    2. No, I am not at least 21 years of age
15. Are you a resident of the City of Coldwater?*

    1. Yes, I am a resident of the City of Coldwater
    2. No, I am not a resident of the City of Coldwater
17. How long have you lived in the City?*
19. Are you a registered voter in the City of Coldwater?*

    1. Yes, I am a registered voter in the City of Coldwater
    2. No, I am not a registered voted in the City of Coldwater
20. Do you own property in the City of Coldwater?*

    1. No, I do not own property in the City of Coldwater
    2. Yes, I own property in the City of Coldwater
22. Educational Background*

    Please tell us about your educational background

24. Professional Qualifications and or Work Experience*

    Please tell us about your professional qualifications and or work experience

26. Volunteer and or Community Engagement Experience*

    Please tell us about your volunteer or community engagement experience

28. Please list all relevant skills that would assist you in performing the duties of a board and commission member*
29. Have you served on a board or commission or held a civic position in the past?*

    1. Yes
    2. No
30. Do you foresee any potential conflicts of interest while executing the duties of this position?*

    1. Yes
    2. No
32. What are the reasons you wish to serve on a board or commission?*
34. Have you reviewed the current meeting schedule of the board or commission and can you commit to regular meeting attendance?*

    1. Yes
    2. No
35. Is there anything else you would like us to know in our considerations?
37. Electronic Signature

    In the section that follows, you will read the Electronic Signature Agreement. There will then be a question surrounding it. Please be sure to read through this section carefully. Any questions can be addressed to the City of Coldwater at (517) 279-9501. Thank you. 

    By checking the "I agree" box in the question that follows, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate matter, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature and 3) you may still be required to provide a traditional signature at a later date. 

39. Please select the I agree box below*

    1. I agree
    2. I do not agree and will no longer be eligible for this application.
40. Please provide your name below.*

    This will serve as your electronic signature.

41. Please input today's date.*
    Please input today's date.
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field