Form Center

2. Boards, Commissions, and Committees Application

   This application is subject to the Colorado Open Records Act and should not be considered confidential.

4. First Name*
5. Last Name*
7. Address1*
9. Address2
11. City*
12. State*
13. Zip*
15. Email Address*
16. Phone Number*
18. Occupation*
19. Employer*
21. Board, Commission, or Committee of Interest*

    Please indicate which Board, Commission or Committee you would like to apply for. You may select more than one.

    1. Building Appeals Board
    2. Frederick Arts Committee
    3. Historic Preservation Committee
    4. Parks, Open Space, and Trails Commission
    5. Planning Commission
    6. Frederick Urban Renewal Authority
23. Please summarize the experience and expertise that you would bring to the Board, Commission, or Committee you are applying for.*
25. How Much Time Are You Able to Devote?*
27. The Town of Frederick is committed to a culture of FRED (Family, Respect, Empowerment, and Dedication), how do you feel you can contribute to the advancement of the FRED culture in the community?*
29. Conflict of Interest Disclosure*

    Several state laws and municipal ordinances prohibit conflicts of interest on the park of Boards, Commissions, and Committee members.  A member of a Board/Commission/Committee shall not perform an official act that may have an economic benefit on a business or other undertaking (whether or not for profit) in which the member has a direct or substantial financial interest.  Board/Commission/Committee members must not be interested in any contract made in their official capacities; or made by any other body, agency, or board of which they are members or employees. Please indicate whether you would have any conflicts while serving as a member of a Board/Commission/Committee.

    1. Yes
    2. No
31. If you checked yes please explain your conflict in detail.
33. By signing below I certify that all information is true and correct to the best of my knowledge.*
35. Date
    Date
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit Submit and Print

* indicates a required field