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2. Date*
   Date
4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip*
13. Email*
14. Phone*
16. Place of Employment
18. How long have you been a resident of Roeland Park?
19. How much time do you have to devote per month?
21. Board & Committee Interest*
    Briefly describe why you are interested in serving on a board or committee for the City of Roeland Park.
23. Select a Board or Committee*

    Please select which board or committees you are interested in serving on (only one per application).

    *When submitting an application for Council Member please provide letter of interest and resume.

    1. Arts
    2. Board of Zoning Appeals
    3. Community Foundation
    4. Community Engagement
    5. Parks
    6. Planning Commission

    1. Aquatic Advisory Committee
    2. Sustainability
    3. Diversity, Equity and Inclusion Committee
    4. Ad-Hoc Historical Committee
    5. Other
    6. Council Member
25. Are you a high school student between the ages of 14 and 18?*

    1. Yes
    2. No
27. Additional Comments
    Please provide any additional comments, if any.
29. Resume
    Please provide a copy of your resume.
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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field