Form Center

2. The following information may be released to the general public pursuant to a Freedom of Information Act request.
4. Name of Board/Commission applying for:*
   -- Select One --Albemarle-Charlottesville Regional Jail AuthorityBoard of Architectural ReviewBoard of Zoning AppealsBuilding Code Board of AppealsCAT Advisory BoardCharlottesville Affordable Housing Fund Committee (CAHF) Charlottesville Economic Development AuthorityCharlottesville Redevelopment and Housing AuthorityCharlottesville-Albemarle Airport AuthorityCharlottesville-Albemarle Airport CommissionCharlottesville-Albemarle Convention & Visitors Bureau Executive BoardCitizen Transportation Advisory CommitteeCommunity Development Block Grant Task ForceCommunity Policy and Management TeamElectoral BoardHistoric Resources CommitteeHousing Advisory CommitteeHuman Rights CommissionJAUNTJefferson Area Board for Aging Advisory Council on AgingJefferson Area Board for Aging Board of DirectorsJefferson Area Community Criminal Justice BoardJefferson-Madison Regional Library BoardMeasurement and Solutions GroupMinority Business CommissionMonticello Area Community Action Agency BoardParking Advisory PanelParks and Recreation Advisory CommitteePersonnel Appeals BoardPiedmont Family YMCA Board of DirectorsPiedmont Virginia Community College BoardPLACE Design Task ForcePlanning CommissionPolice Civilian Review BoardRegion Ten Community Services BoardRetirement CommissionRidge Street Priority Neighborhood Task ForceRivanna River Basin CommissionRivanna Solid Waste AuthorityRivanna Water and Sewer AuthoritySister City CommissionSocial Services Advisory BoardTowing Advisory BoardTree CommissionVendor Appeals BoardWater Resources Protection Program Advisory CommitteeYouth Council
6. Title of the position applying for (if applicable):
8. First Name*
9. Last Name*
11. City Resident? (Please Select One)*

    1. Yes
    2. No
12. How long have you lived in the City of Charlottesville?
14. Schools attended, degrees, graduation dates:
16. Memberships in fraternal, business, and/or social groups:
18. Public, civic and charitable offices and/or activities:
20. Interests aside from profession:
22. Reasons for wanting to serve on this board/commission:
26. The following information will be classified as personnel information pursuant to Virginia Code Section 2.2-3705.1 and the Council will not release this information to the general public pursuant to a Freedom of Information Act request.
28. Home Address
30. City
31. State
32. Zip Code
34. Previous Residence
36. City
37. State
38. Zip Code
40. Occupation & Title
41. Employer:
43. Business Address
45. City
46. State
47. Zip Code
49. Phone Number*
51. Email Address*
53. Upload your resume (optional)
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field