Comprehensive Plan Advisory Committee

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Application

Please correct the field(s) marked in red below:

1

Full Name

2

My home of residence is in Council District:

My home of residence is in Council District:
3

Current Address (include street, city, state and zip code)

4

Home Telephone:

5

Mobile Telephone

6

Work Phone

7

Ethnicity:

8

Gender

Gender
9

Highest Level of Education Completed

Highest Level of Education Completed
10

Present Employer (include name of company and company address):

11

Current Position:

 *
12

How long have you been a resident of Dorchester County?

13

Do you currently serve on any local or state boards, commissions, committees and/or hold an elected office? If yes, please list.

14

Use this section to provide any qualifications and pertinent professional experience that qualifies you to serve on the Comprehensive Plan Advisory Committee.

By typing your name in the space below you attest that, if appointed to the Comprehensive Plan Advisory Committee, you will attend all stated and called meetings of the advisory committee. If you are absent from three consecutive meetings, or if you are absent from half of the meetings within a six-month period, you will resign your appointment. However, if the Chairperson excuses your absence prior to the meeting, in recognition of circumstances beyond your control (illness, family emergency, etc.), then you are entitled to retain your position on the advisory committee.

 

15

Digital Signature

 

Note: Typing your first and last name below indicated acknowledgement of the above statement and that all information you have provided in this application is true and correct to the best of your knowledge

 

  1. To receive a copy of your submission, please fill out your email address below and submit.