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Application for Appointment to a Board or Commission

2. City of Valparaiso Application for Appointment Form
   The City of Valparaiso invites the community to submit applications to serve on city boards and commissions, responsible for reviewing city plans and helping to shape decisions for Valparaiso’s future.
4. View more information about each Board/Commission/Committee, including purpose and when they meet, by visiting our website with the link below.
   Learn more.
6. Position Sought*

   1. Advisory Human Relations Council
   2. Board of Zoning Appeals
   3. Economic Development Commission
   4. Fire Territory Board**
   5. Historic Preservation Commission
   6. Impact Fee Review Board
   7. Park Board**
   8. Plan Commission**
   9. Redevelopment Commission
   10. School Board** (additional form will be required)
   11. Utilities Board**

   **To ensure balanced representation, some Board/Commission/Committee appointments are mandated to require the disclosure of party affiliation.
8. First Name*
9. Last Name*
11. Phone*
12. Email*
14. Street Address*
15. Zip*
17. Are you a resident of Valparaiso? Note, most appointments require Valparaiso residency.*

    1. Yes
    2. No
18. If you are a resident, how long have you lived in Valparaiso?*
20. Current Employer*
21. Position
23. What is your political affiliation? Certain seats may be party-specific.

    Generally, party affiliation is determined by your ballot selection in the last primary election.

    1. Democrat
    2. Republican
25. Most Board/Commission/Committee meet monthly in the evening. If appointed, are you able to attend the days/times of the regularly scheduled meetings?*

    1. Yes
    2. No
27. Do you hold any certifications or degrees that relate to this position? Please list.
29. Why do you wish to serve on this Board/Commission/Committee?
31. What personal experiences do you have that may aid your participation on this Board/Commission/Committee?
33. Have you ever served on a public or private Board/Commission/Committee? If so, describe your experience during your term and any positive accomplishments.
35. If you could improve one thing in Valparaiso, what would it be, and why?
37. Form Submission
    Upon submission of this form, it becomes public record. Forms will be reviewed by the Mayor and City Council as vacancies occur. Note that some boards/commissions have longer terms than others and vacancies may not occur frequently.
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field