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2. 
4. Select the Board/Commission on which your are interested in serving.
   -- Select One --Business Improvement District No. 1Business Improvement District No. 2Golf Advisory BoardHistoric Preservation CommissionHuman Relations CommissionJoint Powers Solid Waste Advisory BoardLibrary Board of TrusteesPlanning & Zoning CommissionTree BoardVermillion Housing Authority
5. Are you expressing interest for the Human Relations Commission Post-secondary student? *
   -- Select One --YesNo
7. Name
8. Number of years you have lived in/around Vermillion
10. Address
11. Phone Number
12. Email Address
14. Occupation
15. Employer
16. Business Address
18. Prior elected or appointed offices held (if any)
19. Present and past community volunteer activities
21. Why are you interested in serving on this Board/Commission?
22. Do you have any unique skills or experience which would be beneficial to the City to know in selecting someone to serve?
24. The ordinance establishing the Historic Preservation Commission contains the section listed below. So the City Council can evaluate the qualifications of each candidate, please advise about your background in any of the categories listed in section C below. Please contact the City Manager’s Office (605-677-7050) if you have any questions. *

    § 32.32 MEMBERSHIP; APPOINTMENT; QUALIFICATIONS; TERMS. (A) The Commission shall consist of seven members, who shall be appointed by the Mayor, subject to approval by the City Council, and with consideration of the existing city historic districts and those residents who have expertise and interest in such fields as history, architecture, urban planning, archaeology, paleontology, and law as available. (B) When available in the community, four of the seven members of the Commission are to be owners in one of the officially designated Historic Districts within the City of Vermillion. (C) When available in the community, two of the seven members of the Commission are to have expertise in the disciplines of history, architectural history, architecture, planning, urban planning, American studies, American civilization, cultural geography, cultural anthropology, or related fields. (D)All members of the Commission shall reside within the City of Vermillion and shall serve for terms of three years and shall be eligible for reappointment. The terms of the original members shall be varied in order to assure that no more than one-third of the appointments shall be for a full three year term with the remaining appointments divided between one and two year terms. Persons appointed to fill an unexpired term shall serve for the remainder of the term. (E) Any member who fails to attend three consecutive meetings without presenting an explanation accepted by the Commission may be deemed to have abandoned the office and may be replaced as provided herein. (F) City Council shall act to fill any vacancy, which may occur.

26. Are there any particular projects, programs or goals you would like to see achieved while serving on the Board/Commission?
28. 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.
30. Electronic Signature*
31. Date:*
    Date:
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33. 1. Receive an email copy of this form.
34. Email address

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35. Submit

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