2. Today's Date*
   Today's Date
4. Committee, Commission, or Board I am applying for:*

   An application must be completed for each individual Committee, Commission, or Board for which you wish to apply.

   1. Arrowhead Library Board
   2. Bowstring Airport Commission
   3. Extension Committee
   4. Grand Rapids/Itasca County Airport Advisory Board
   5. Housing & Redevelopment Authority (HRA)
   6. Nursing Home Board
   7. Park & Recreation Commission

   1. Personnel Board of Appeals
   2. Planning Commission/Board of Adjustment (PC/BoA)
   3. Sheriff Civil Service Commission
   4. Tri-County Community Health Board
   5. Water Plan Implementation Committee (WPIC)
   6. Other - Not Listed
6. Other - Not Listed
8. Are you currently appointed to this Committee/Commission/Board?*

   1. Yes
   2. No
9. How long have you served this Committee/Commission/Board?*
11. First Name*
12. Last Name*
14. Mailing Address*
16. City*
17. State*
18. Zip Code*
20. Phone Number*
21. Alternate Phone Number
22. Email Address*
24. Commissioner District*
    -- Select One --District #1District #2District #3District #4District #5Unknown

    Please select the Commissioner District in which you reside.
25. Years in Itasca County:
    Please indicate how many years you have resided in Itasca County:
27. Current Employment Status:
    -- Select One --Employed Full-TimeEmployed Part-TimeSelf-EmployedRetiredOther
28. Highest Degree or Level of School Completed:
    -- Select One --High School or equivalentSome College, no degreeTrade/Technical/Vocational TrainingAssociate's DegreeBachelor's DegreeMaster's DegreeProfessional DegreeDoctorate Degree
30. Other Work Experience:
32. Committee Related Experience:
34. Community Activities & Interests:
36. Additional Comments:
38. Why are you willing to devote time and energy to serving the Itasca County Planning Commission/Board of Adjustment (PC/BoA)?
40. There will be monthly or semi-monthly site inspections and hearings of the Itasca County Planning Commission and Board of Adjustment (PC/BoA). Would you be able to attend these sessions throughout the year?

    1. Yes
    2. No
41. When could you not attend?
43. What is your viewpoint with regard to zoning issues and maintaining orderly development?
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit Submit and Print

* indicates a required field