2. City of Texarkana

   Board / Commission / Committee 

   Membership Application

4. City Secretary’s Office
    220 Texas Blvd.
    Texarkana, TX 75501

8. First Name*
9. Last Name*
11. Home Address:*
13. City*
14. State*
15. Zip*
17. Business Address:
19. City
20. State
21. Zip
23. Home Phone:*
24. Business Phone:
25. Cell Phone:*
26. Fax:
28. Email address:*
29. Voter Registration Number:
31. Length of time lived in Texarkana?*
32. At this address?*
34. Do you have any delinquent taxes, utilities, or other assessments owed to the City?*
36. Do you have any pending claims or litigation against the City?*
40. Board/Commission/Committee Desired
42. POSITION SOUGHT: Please indicate your choices with 1, 2 or 3; where 1 is the most desired and 3 the least. (Applications will be kept on file for one (1) year)
44. Airport Authority
    -- Select One --N/A123
45. Board of Adjustment
    -- Select One --N/A123
46. Building & Standards Commission
    -- Select One --N/A123
47. Civil Service Commission
    -- Select One --N/A123
49. Community Healthcore
    -- Select One --N/A123
50. Historic Landmark Preservation Committee
    -- Select One --N/A123
51. Housing Authority
    -- Select One --N/A123
52. Industrial Development Corporation
    -- Select One --N/A123
54. Keep Texarkana Beautiful
    -- Select One --N/A123
55. Library Commission
    -- Select One --N/A123
56. Permit and License Appeal Board
    -- Select One --N/A123
57. Planning and Zoning Commission
    -- Select One --N/A123
59. Tax Increment Reinvestment Zone (TIRZ)
    -- Select One --N/A123
60. University Planned Development District (UPDD)
    -- Select One --N/A123
64. Professional/Occupational Information
66. Education:
68. Institution/School:*
69. Diploma/Degree:*
70. Year:*
72. Employment:
74. Employer:*
75. Position:*
76. Dates:*
78. Professional Licenses:
80. Professional Associations/Memberships:
82. Civic/Volunteer Organizations & Activities
86. Sign and return application to the City Secretary’s Office

88. I understand that if I should be appointed to a board, commission, or committee, I will be expected to participate actively in the business of the respective board, commission, or committee. I also understand that I will be expected to complete the Texas Attorney General training videos for the Texas Open Meetings and Public Information Acts.
    
    I agree to adhere to the attendance requirements of said board, commission, or committee.
    
    I agree to contact the City Secretary’s Office if there is any change in my information as submitted on this application.
    
    I understand that should a situation arises during my term on said board, commission, or committee, where I have a prohibited substantial interest, either direct or indirect, and such matter comes before said board, commission, or committee, I understand that I will need to abstain from any discussion or vote on the matter.
    
    I have read, understand, and completed this application to the best of my ability and that the information contained herein is true and correct. 

90. First Name*
91. Last Name*
93. Signature:*
94. Date:*
98. Questionnaire
100. 1. Do you currently serve on any other City Boards/Commissions/Committees? If yes, please list.*
102. 2. Why are you interested in serving on a City Board/Commission/Committee?*
104. 3. Do you feel you can commit the time to serve effectively should you be appointed to serve?*
106. 4. What do you consider to be the top three (3) issues affecting the City of Texarkana?*
108. 5. How many City Council meetings have you attended in the past 12 months?*
109. 6. Have you attached your resume or letter of interest with this application?*

     1. Yes
     2. No
110. 7. Upload a document

     Upload any relevant documents here.

Leave This Blank:


112. 1. Receive an email copy of this form.
113. Email address

     This field is not part of the form submission.

114. Submit

* indicates a required field