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2. First Name*
3. Last Name*
5. Select the Board, Commission, or Committee applying for*
   -- Select One --Select OneAffordable Housing Supply Advisory BoardAirport BoardBuilding Appeals BoardBoard of HealthEnergy Conservation Works BoardFair BoardHistoric Preservation BoardIntegrated Solid Waste & Recycling BoardLibrary BoardParks & Recreation BoardPathways TaskforcePlanning CommissionRegional Housing Authority BoardSTART BoardTeton County Weed & Pest District BoardTravel & Tourism BoardWater Quality Advisory Board
7. Have you served on this Board before?
9. Are you Currently Employed by Teton County Government or the Town of Jackson Government?*

   1. Yes
   2. No
11. Personal Information
13. Address1*
15. Address2
17. City*
18. State*
19. Zip*
21. Home Phone Number*
23. Business Address*
25. Business Phone Number*
27. Occupation*
29. Email Address
31. Residency Information
33. Length of Residency in Teton County*
35. Are you a registered voter in Teton County?*

    1. Yes
    2. No
37. Education and Hobbies
39. High School
41. College
43. Trade or Business School
45. Hobbies
47. Organization Membership Information
49. Have you served on a Board, Commission, or Committee before?*

    1. Yes
    2. No
51. If yes, which
53. Are you currently serving on other Boards, Commissions, or Committees?*

    1. Yes
    2. No
55. If yes, which
57. Please list organizational memberships or affiliations and positions held.
59. Please List Areas of Special Interest:
61. Please provide your knowledge of the duties & responsibilities of the Board you are applying for:
63. Why do you want to serve on this Board?
65. What are your qualifications for serving on this Board?
67. What experience and/or special training do you have that is pertinent to this Board's efforts?
69. What is your understanding of the time and service requirements of this Board and how are you prepared to meet them?
71. Do you have any scheduling conflicts you are aware of?
73. If selected for service on this Board do you commit to abiding by the Teton County Board Member Expectations?
    -- Select One --YESNO
74. See Below:
    Teton County Board Member Expectations
76. Resume
    Due to interview time being limited the submission of a resume is strongly encouraged. Upload your resume and references here.
77. References
    Due to interview time being limited the submission of a references is strongly encouraged. Upload your resume and references here.
79. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
81. Electronic Signature
Leave This Blank:


83. 1. Receive an email copy of this form.
84. Email address

    This field is not part of the form submission.

85. Submit

* indicates a required field