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Citizen Appointment Application

2. COMMITTEES*
   -- Select One --Accommodations Tax CommitteeBuilding AuthorityDepartment of Human Services BoardHealthWest (formerly CMH) Board*Land Bank AuthorityMuskegon Port Advisory BoardRemonumentation Peer Review GroupSenior Activities CommitteeVeterans' Advisory CommitteeAirport Advisory CommitteeCommunity Corrections AdvisoryEconomic Development CorporationLakeshore Museum BoardMSU Extension CouncilPublic Health Advisory CommitteeRoad CommissionSolid Waste Planning CommitteeWhite River/Natural River Zoning BoardLRE Substance Abuse Committee

   Please select the Committee on which you wish to be considered. If you would like to be considered for multiple committees, please fill out a form for each.

4. * If HealthWest Board is of interest, please indicate if you have Lived experiences with any of the following:

   1. Mental Illness

   1. Developmental Disabilities

   1. Substance Use Disorder

   (Select all that apply.)

6. Name

7. Email Address*

9. Home Address*

11. City*

12. State*

13. Zip Code*

15. Employer Address

17. City

18. State

19. Zip Code

21. Personal Phone*

22. Work Phone

24. Gender

    (voluntary)

25. Ethnicity

    (voluntary)

27. What special experience, education or interest do you have for serving on the board/committee you have selected?*

29. What special skills do you feel you could bring to this committee/board?*

31. What other boards/committees do you currently serve on, or have you served on in the past?*

33. Upload Cover Letter

    Please submit files in PDF format only.

34. Upload Resume

    Please submit files in PDF format only.

Leave This Blank:


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

    This field is not part of the form submission.

38. Submit Submit and Print

* indicates a required field