Form Center

2. Name (First, Middle Initial, Last)*
4. Date*
6. Street Address*
8. City/Town*
10. State*
12. Zip*
14. Mailing Address*
16. City/Town*
18. State*
20. Zip*
22. Home Phone*
24. Cell Phone*
26. Email Address*
28. Select the below Board(s) or Commission(s) you are interested in serving on.*

    1. Affordable Housing Collaborative Committee
    2. Board of Canvassers
    3. Coastal Access Improvement Committee
    4. Conservation Commission/Tree Board
    5. Economic Development Commission
    6. Finance Committee
    7. Galilee Advisory Committee
    8. Harbor Management Commission
    9. Historic District Committee
    10. Historical Cemetery Commission
    11. Housing Authority
    12. Inclusion, Diversity, Equity and Awareness Committee
    13. Juvenile Hearing Board
    14. Land Conservancy Board
    15. Library Board of Trustees
    16. Narragansett South Kingstown Senior Advisory Committee
    17. Pension Board
    18. Personnel Appeal Board
    19. Planning Board
    20. Recreation Advisory Board
    21. Tax Assessment Board
    22. Towers Committee
    23. Zoning Board of Review/Minimum Housing Board
    24. Other
30. What expertise, if any, would you bring to the above-listed Board, Committee or Commission(s)?
32. Please provide a brief description of your job experience:
34. Please provide a brief description of your educational background:
36. Please provide a detailed statement of interest:
38. Do you anticipate having to refrain from participating in discussion and voting on any particular matter(s) that may come before said Board, Committee, or Commission(s) because of a conflict of interest? If so, please explain.
40. Attachments
42. 
    
44. Please give the date you last came to reside in Narragansett*
46. 
    
48. Please be advised that appointment to the Zoning Board and Planning Board and some of our other boards require time during the regular work day to review plans and conduct site inspections. Do you understand the time requirements necessary to serve and are you able to make that commitment?*
    -- Select One --YesNo
50. To review the Guide to Rhode Island's Laws on Open Meetings please visit: RIGL 42-46-4 & RIGL 42-46-5
52. Zoning Board & Planning Board Applicants Only

    To review the Rhode Island Ethics Commission's financial disclosure requirements, overview of the Executive Director relative to the requirements for recusal and representing oneself before a Board or Commission which he/she is a member please visit:
    http://www.ethics.ri.gov
54. Please enter your name as signature*
55. Date of affirmation*
57. Note: Application will stay on file in the Clerk's Office for (2) years.
Leave This Blank:


59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit

* indicates a required field