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3. 
5. BOARD, COMMISSION, AND COMMITTEE APPLICATION
7. NOTE:

   As an applicant for a City Board or Commission this information will be available under the provisions of the Public Information Act.

11. PERSONAL INFORMATION
13. NAME*
15. HOME ADDRESS*
16. CITY*
17. STATE*
18. ZIP*
20. MAILING ADDRESS

    If different from above

21. CITY
22. STATE
23. ZIP
25. PHONE NUMBER*
26. PHONE TYPE*

    1. BUSINESS
    2. HOME
    3. CELL
27. EMAIL ADDRESS*
29. RESIDENCY*

    Some boards or commissions may have residency requirements. 

    1. KEMAH RESIDENT
    2. GALVESTON COUNTY (outside Kemah)
    3. HARRIS COUNTY RESIDENT (within 10 miles of Kemah)
    4. OTHER
30. HOW LONG?*
32. ARE YOU OR ANY MEMBERS OF YOUR HOUSEHOLD CURRENTLY SERVING ON A CITY OF KEMAH PUBLIC APPOINTED OFFICE, BOARD, COMMISSION, OR COMMITTEE *

    1. YES
    2. NO
33. IF YES, WHICH BOARD?
35. HAVE YOU PREVIOUSLY BEEN A MEMBER OF A CITY OF KEMAH PUBLIC APPOINTED OFFICE, BOARD, COMMISSION, OR COMMITTEE*

    1. YES
    2. NO
36. IF YES, WHICH ONE?
38. DO YOU, YOUR IMMEDIATE FAMILY; OR YOUR EMPLOYER HAVE ANY DEALINGS WITH AN ENTITY OR INDIVIDUAL THAT MAY PRESENT A CONFILICT OF INTEREST IN CONNECTION WITH YOUR SERVING ON THE BOARD IN WHICH YOU SEEK TO SERVE? *

    1. YES
    2. NO
42. BOARDS, COMMISSIONS, AND COMMITTEES

    Note: some Boards require a resume, interview and/or additional information.  

    • Kemah Community Development Corporation (KCDC)
    • City of Kemah Municipal Management District #1 (MMD1)
    • Galveston County Animal Services Advisory Committee Application
    • Community Events Committee
44. BOARD, COMMISSION, OR COMMITTEE YOU ARE APPLYING FOR*

    1. KCDC
    2. MMD1
    3. Galveston County Animal Services Advisory Committee
    4. Community Volunteer
46. WHY WOULD YOU LIKE TO SERVE ON THIS BOARD, COMMISSION OR COMMITTEE?*
50. PLEASE LIST ANY CIVIC OR COMMUNITY ENDEAVORS IN WHICH YOU HAVE BEEN INVOLVED*
52. WHAT EXPERIENCE DO YOU HAVE THAT MAY QUALIFY YOU FOR SERVICE ON YOUR SELECTED BOARD, COMMISSION OR COMMITTEE?*

    Please include and relevant licenses, degrees, or certifications. 

54. PERSONAL REFERENCES
56. Name*
57. Name*
58. Name
60. Address*
61. Address*
62. Address
64. Daytime Phone #*
65. Daytime Phone #*
66. Daytime Phone #
70. THIS SECTION IS FOR KCDC AND MDD1 APPLICANTS ONLY

    • I understand that applications for KCDC positions will be interviewed by City Council. I will be contacted by the City Secretary's Office for an interview date and time.
    • I understand that, if appointed, I must adhere to  Ordinance No. 1101, which requires all members of the City Council and KCDC to complete a disclosure statements within 30 days of appointment.
    • I understand that State law requires that I undergo on hour of training concerning the Open Meetings Act within 90 days of my appointment

    1. I AGREE
72. SEE ORDINANANCE
    Ordinance 1101
76. I hereby affirm the information herein is true and correct to the best of my knowledge.
78. Signature*
79. 
    
81. Date*
83. COVER LETTER

    Optional

85. RESUME

    Optional (except for KCDC and MDD1)

Leave This Blank:


87. 1. Receive an email copy of this form.
88. Email address

    This field is not part of the form submission.

89. Submit Submit and Print

* indicates a required field