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2. Type of Appointment

   Please select one of the following

   1. Adult New
   2. Youth New
   3. Adult Reappointment
   4. Youth Reappointment
3. # of years served
   For Reappointments please indicate # of years served
5. Board/Committee(s)/Commission(s)

   Please indicate the Board/Committee(s)/Commission(s) to which you are interested in being appointed:

   1. Human Services Advisory Committee
   2. Social Services Task Force
   3. Mental Health Task Force
   4. Community Corrections Advisory Board
   5. Extension Committee
   6. Recycling Education Committee

   1. Planning Commission
   2. Environmental Services Advisory Board
   3. Planning Commission
   4. Board of Adjustments
   5. Park Advisory Board
7. Order of Preference
   If you have marked multiple boards/ committees/ commissions to be appointed please provide your top three (3) request in order of preference
11. Applicant Information
    Please note, you must be a resident of Blue Earth County
13. Date of Application
15. First Name
16. Last Name
18. Address
20. Phone Number
21. Email Address
25. Briefly tell us why you want to serve and/or continue to serve on this Board/Committee/Commission:
27. If this is a reappointment, briefly describe your experiences while serving on this Board/Committee/Commission:
29. List any special background or experience you have which would be helpful to this Board/Committee/Commission:
31. List your educational background:
33. List any social, fraternal, patriotic, governmental, or service organizations, which you have or currently are serving on:
35. If you are employed, please provide the name and address of your employer and your position:
Leave This Blank:


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

    This field is not part of the form submission.

39. Submit

* indicates a required field