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2. Application for Appointment to City Advisory Board or Commission
   One of the highest ideals of citizenship if personal involvement in the democratic process. City Advisory Boards and Commissions provide participation in issues concerning the community and its residents. We welcome your application to serve on a City Advisory Board or Commission. Please furnish complete information to assist us in giving your application full consideration. Additional information, which further qualifies you, may be attached to this application.
4. Select the Advisory Board or Commission applying for*

   Check all that apply

   1. Airport Advisory Commission*
   2. Charter Commission
   3. Civil Service Commission
   4. Library Board

   1. NCD4
   2. Parks & Recreation Advisory Commission
   3. Planning Commission
   4. LMRWMO
6. *If applying for the Airport Advisory Commission, please indicate your association with Fleming Field Airport

   Check all that apply

   1. Airport Tenant's Association
   2. Airport User - Hangar Owner
   3. Airport User - Aircraft Owner and Hangar Renter
   4. Airport Neighbor - IGH Resident

   1. Airport Neighbor - SSP Resident
   2. Airport Non-Profit Organization
   3. Airport Business Community
8. Top Choice*
   List which Advisory Board or Commission you are most interested in serving on.
10. Personal Information
12. First Name*
13. Last Name*
15. Address1*
17. Address2
19. City*
20. State*
21. Zip*
23. Phone Number*
25. Email Address*
27. Employer*
29. Occupation*
31. Qualifications
    Please answer the following questions.
33. Do you have any special qualifications that you feel would help you be effective on a board or commission (i.e. work experience, education, volunteer experience, etc.)?
35. List two or three goals that you would like to see accomplished during your service.
37. What is your primary interest in serving on a City of SSP Advisory Board or Commission?
39. Organization Membership Information
41. Are you currently serving on other Boards, Commissions, or Committees?*

    1. Yes
    2. No
43. If yes, which
45. Have you served on a Board, Commission, or Committee before?*

    1. Yes
    2. No
47. If yes, which
51. Consent to Release Private Data
    If appointed to an Advisory Board or Commission, I authorize the City of South St. Paul to release the following private data upon request made to the City. You must list at least one phone number or email address to be made public.
53. Phone Number
54. Business Phone Number
56. Personal Email Address
57. Business Email Address
59. I also authorize the City of South St. Paul to release such authorized private data referenced above to members of the general public, City staff, Mayor and City Council members. This authorization shall be modified or cancelled only upon written notice to the City of South St. Paul, 125 3rd Ave. N., South St. Paul, MN 55075. I agree to relinquish and waive all claims that may arise against the City, its agents or employees for releasing any and all authorized data referenced above relating to this agreement.
61. By submitting your application electronically, you have agreed to all terms listed above.
63. Additional Information
    Please upload any additional information for consideration.
Leave This Blank:


65. 1. Receive an email copy of this form.
66. Email address

    This field is not part of the form submission.

67. Submit Submit and Print

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