Name (First, Middle Initial, Last)*

Date*

Street Address*

City/Town*

State*

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip*

Mailing Address*

City/Town*

State*

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip*

Home Phone*

Cell Phone*

Email Address*

Select the below Board(s) or Commission(s) you are interested in serving on.*

Board of Canvassers Conservation Commission/Tree Board Finance Committee Galilee Advisory Committee Harbor Management Commission Historic District Committee Historical Cemetery Commission Housing Authority Juvenile Hearing Board Land Conservancy Board

Library Board of Trustees Pension Board Personnel Appeal Board Planning Board Recreation Advisory Board Tax Assessment Board Towers Committee Zoning Board of Review/Minimum Housing Board Other

What expertise, if any, would you bring to the above-listed Board, Committee or Commission(s)?

Please provide a brief description of your job experience:

Please provide a brief description of your educational background:

Please provide a detailed statement of interest:

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.

Attachments

Convert to PDF?
(DOC, DOCX, XLS, XLSX, TXT)

Please give the date you last came to reside in Narragansett*

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?*

Yes No

To review the Guide to Rhode Island's Laws on Open Meetings please visit: RIGL 42-46-4 & RIGL 42-46-5

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

Please enter your name as signature*

Date of affirmation*

Note: Application will stay on file in the Clerk's Office for (2) years.