2. Please complete the online form below. Please be aware that the information given on your application is made available to the public. Staff will require the use of a mailing address, email address, and contact phone number to provide board and meeting information.
4. PERSONAL INFORMATION
6. Select the Board, Commission, or Committee applying for*
   -- Select One --Select OneAirport Fire Protection Service Area BoardArchitectural/Engineering Review BoardBay View Road Service Area BoardBoard of EqualizationConsolidation CommitteeFire Protection Area No. 1 BoardKodiak Fisheries Advisory CommitteeLands CommitteeMarijuana Task ForceMission Lake Tide Gate Service Area BoardMonashka Bay Road Service Area BoardParks and Recreation CommitteePersonnel Advisory BoardPlanning and Zoning CommissionService Area No. 1 BoardService Area No. 2 BoardSolid Waste Advisory BoardTrinity Islands Street Lights Service Area BoardWomens Bay Service Area BoardWoodland Acres Streetlights Service Area BoardKodiak Workforce Regional Advisory CouncilPrince William Sound Regional Citizens Advisory Council (PWSRCAC)
8. Designated seat or group representation (if applicable):
10. Full Name*
12. Residence Address*
14. Mailing Address *
16. Email Address (This address will be used for correspondence)*
18. Home Phone Number (numeric only)*
19. Work Number (numeric only)*
21. Cell or Fax Number (numeric only)*
22. Employer/Occupation*
24. RESIDENCY INFORMATION
26. Length of residency in Kodiak*
28. Registered to vote in Kodiak?*

    1. Yes
    2. No
30. FOR SERVICE AREA BOARD APPLICANTS
32. Length of Residence in Service Area
34. ORGANIZATION MEMBERSHIP INFORMATION
36. Are you currently serving on other Boards, Commissions, or Committees?*

    1. Yes
    2. No
38. If yes, which
40. Organizations you belong to or participate in
42. Explain your main reason for applying
44. What background, experience, or expertise will you bring to the board/committee/commission membership?
46. Are you available for regular meetings?*

    1. Yes
    2. No
48. Pursuant to KIBC 2.100.070 (A.6) and 4.15.070 (A.7) Other than by expiration of the members term, the assembly shall declare a seat vacant when a member of the board misses three consecutively held regular meetings and is not excused.
50. FOR CLERKS OFFICE STAFF ONLY
52. Registered Voter of the Borough: Y______ N ______
54. Applicant's Residence: Borough_______ City ______
56. Date of Appointment
57. Term Expires On
59. Appointment Letter
60. Roster
61. Oath of Office
63. APOC POFD Statement: N/A ________ Attached ________ On File ________
Leave This Blank:


65. 1. Receive an email copy of this form.
66. Email address

    This field is not part of the form submission.

67. Submit Submit and Print

* indicates a required field