NAME *

First

Last

Address *

Address Line 1

City

State

Zip Code

Mailing Address(if different)

Contact Number *

EMAIL *

Are you a qualified voter in the City of Mount Pleasant? *

Yes
No

Do you live within the city limits? *

Yes
No

If yes, how long?

Employer name, address, and occupation *

To the best of your knowledge, are you employed by, or a member of, any entity (business or non-profit) with proposals, programs, requests, businesses, applications, licenses, or any other matters which may come before a board or commission for review, funding, support, or approval during the next two years? *

Yes
No

If yes, list entity and interest:

Volunteer Experience/ Community Service *

What do you hope to accomplish by serving? *

Are by, live

Board(s), Commission(s), or Committee Interest *

What experience qualifies you to serve on the Planning & Zoning or Board of Adjustments?

Leave blank if you're not applying for Planning & Zoning or Board of Adjustments

Signature of Applicant *

Date *

THANK YOU FOR YOUR INTEREST IN THE CITY OF MOUNT PLEASANT APPLICATIONS ARE KEPT ON FILE FOR TWO YEARS FROM DATE OF SUBMISSION

CONTACT MPTX

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