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2. First Name*
3. Last Name*
4. Date*
   Date
   Select today's date
6. Address1*
8. Address2
10. City*
11. State
12. Zip*
14. Is this address located within the corporate limits of the Town of Carrboro?*
    -- Select One --YesNo

    Please select Yes or No.
15. Is this address located within the Town's ETJ, Planning Jurisdiction, or Northern Transition Area?*
    -- Select One --ETJNorthern Transition AreaPlanning JurisdictionNoUnsure
17. Telephone (111)-111-1111*
    Please enter your primary contact phone number.
18. Email Address*
    Enter your primary email address.
20. The demographic information provided below is of interest because your elected officials want the Town's advisory boards to reflect the diversity of the Town. Diversity of the applicant pool is a priority of the Board.
22. What Year Were You Born?*
23. Race*
    Please enter your race.
24. Sex*
    Please enter your sex.
25. Ethnicity
27. Occupation*
    Please enter your occupation.
28. Are you a registered Orange County Voter?*
    -- Select One --YesNo

    Please answer Yes or No
29. Length of Residence in Orange County*
    How long have you been a resident of Orange County?
30. Length of Residence in the Town of Carrboro*
    How long have you been a resident of the Town of Carrboro?
32. I wish to be considered for appointment to the following committee/board(s) (Select no more than two (2)):

    1. Board of Adjustment
    2. Economic Sustainability Commission
    3. Climate and Environmental Advisory Commission
    4. Housing and Human Services Commission
    5. OWASA Board of Directors
    6. Orange County Human Relation Commission
    7. Planning Board

    1. Racial Equity Commission
    2. Recreation, Parks & Cultural Resources Advisory Board
    3. Safe Routes to School Implementation Committee
    4. Stormwater Advisory Commission
    5. Tourism Development Authority*
    6. Transportation, Mobility & Greenways Advisory Commission (TMGAC)

    Please note that membership is limited to one advisory board at a time. You shall not be considered for appointment to another board unless you resign before filing an application or you are in the last six months of your current term.

34. Advisory Board Preference*

    Please indicate your preference by typing your first choice. Please limit your selection above to two boards).

35. Other (advisory board not listed):
    Please indicate by typing the advisory board that you are applying for.
37. **Employer/Self Employed
    Please enter your employment information. This is a requirement for application for the Tourism Development Authority.
38. Number of Years Employed
    Enter the number of years you have been employed at the organization listed to the left.
40. ** Provide examples of how you are involved in the promotion of travel and tourism in the Town of Carrboro.
    **Required only for the Tourism Development Authority Application.**
42. Community Activities/Organizational Memberships*
    Please enter the requested information.
44. Relevant Experience:*
46. Reasons You Wish to be Appointed*
48. We believe as a Town and as a Town Council that racial equity and diversity and inclusion are important. Please tell us your thoughts about this and why they are important not only in advisory board/commission work but also in all facets of local government and community work.*
50. Have you ever served on any Town of Carrboro Committee or Board?*
    -- Select One --YesNo
51. If yes, which one(s)?
53. Are you currently serving on a Town Board or Committee?*

    1. Yes
    2. No
54. If yes, are you applying for a third consecutive term?*

    1. Yes
    2. No
56. If yes, please describe how you meet one, or more, of the following exceptions noted below.

    After completing two full terms, a member must take off one year before applying for re-appointment to the same advisory board. However, a board member may apply to serve on another advisory board if he/she desires. The Town Council may make exceptions to this rule under the following circumstances: 1.To retain diversity on an advisory board; 2.A lack of applicants.

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58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit Submit and Print

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