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Citizen Leadership Application

2. Name*

3. Email Address*

5. Address*

7. City*

8. State*

9. Zip Code*

11. Home Phone Number*

12. Cell Phone Number*

14. Certification
    I hereby apply to perform public service on the following municipal authorities, agencies, boards, committees and/or commissions.

    I hereby apply to perform public service on the following municipal authorities, agencies, boards, committees and/or commissions.

16. Please select which of the following you would be interested in serving on. Check All That Apply.

    1. Board of Health
    2. Cable TV Committee
    3. Community Rehabilitation
    4. Emergency Management
    5. Environmental Commission
    6. Ethics Committee
    7. Fire Board (Must be part of the Fire Department)
    8. Fire Police (Must be part of the Fire Department)
    9. Ford Ave. Redevelopment Agency
    10. Green Team
    11. Historic Preservation Committee

    1. Milltown Library Board
    2. Milltown Revitalization Committee
    3. Municipal Advisory Committee
    4. Municipal Alliance
    5. Planning Board
    6. Recreation Advisory Committee
    7. Senior Advisory Committee
    8. Shade Tree Committee
    9. Zoning Board of Adjustment
    10. I will serve on any board, committee or commission as needed
18. Experience

    Please list any education, prior volunteer experience, work related experience, or other civic involvement which could be of use to authorities, boards or commissions which you selected above.

20. Please note that participation or involvement on a Public Authority, Board, Commission or Committee may require member to file a Financial Disclosure Statement with the State of New Jersey annually. Failure to submit a required Financial Disclosure Statement may result in fines.

    Please note that participation or involvement on a Public Authority, Board, Commission or Committee may require member to file a Financial Disclosure Statement with the State of New Jersey annually. Failure to submit a required Financial Disclosure Statement may result in fines.

22. Correspondence, documents created, received, or distributed due to involvement on a Board, Commission or Committee is subject to OPRA (Open Public Records Act) Requests. Personal information not subject to public disclosure pursuant to P.L. 1963 c 73 (C.47:1A-1 et seq.) and P.L. 2001, C. 404 (C. 47:1A-5 et al)

    Correspondence, documents created, received, or distributed due to involvement on a Board, Commission or Committee is subject to OPRA (Open Public Records Act) Requests. Personal information not subject to public disclosure pursuant to P.L. 1963 c 73 (C.47:1A-1 et seq.) and P.L. 2001, C. 404 (C. 47:1A-5 et al)

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24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

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