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2. **Applications may be submitted for consideration at reappointment time or when vacancies occur. They will remain on file for two years.
4. Mayoral appointments are for City of Fitchburg residents unless otherwise noted. Is your residence within the City of Fitchburg?

   1. Yes
   2. No
6. Select the Board, Commission, or Committee applying for*
   -- Select One --Select OneAgriculture and Rural Affairs CommitteeBike CommitteeBoard of Public WorksBoard of ReviewCommission on Aging WellCommunity & Economic Development Authority (CEDA)EMS CommissionHealthy Neighborhoods Advisory CommitteeHousing Advisory CommitteeLandmarks Preservation CommissionLibrary BoardParks CommissionPlan CommissionPolice & Fire CommissionRedistricting CommitteeResource Conservation Commission (RCC)Transportation & Transit Commission (TTC)Tree Advisory CommitteeZoning Board of AppealsI am interested in more than one committee
8. Please indicate other committees you are interested in applying for
10. First Name*
11. Last Name*
13. Preferred Name
14. Preferred Pronouns
16. Address (Public Use)*
18. City*
19. State*
20. Zip*
22. Phone Number (Public Use)*
24. Cell Phone
25. Work Phone
27. Occupation/Title
29. Email (Public Use)
31. PFC Applicants Only:

    If you are an active, dues paying member of a political party, please indicate that party: (This question is for PFC applicants only because Wisconsin State Statue 62.13(1) and Fitchburg Ordinance 6-95 prohibit more than three PFC members from the same political party.)

33. Transportation and Transit Commission Applicants Only
    I hereby certify, in accordance with Fitchburg Ordinance 1.44(2)(B), that I do not hold stocks or bonds in any corporation subject to the jurisdiction of the Transportation and Transit Commission nor am I in any manner pecunialily interested in any such corporation. I also agree, that should I be appointed to the Transportation and Transit Commission, That I shall not acquire any investments in any corporation or organization that violates this section of the Ordinance during the term of my appointment. Signature:
35. Background experience or education that might be pertinent, including volunteer work:
37. Reasons for your interest/willingness to serve the residents of Fitchburg through this appointment:
39. Community activities in which you have participated:
41. Are you currently serving on other Boards, Commissions, or Committees with the City of Fitchburg?*

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

    1. Yes
    2. No
46. If yes, which
48. Please list organization memberships and positions held
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit Submit and Print

* indicates a required field