City of Lake Mills, Wisconsin

On the shores of Rock Lake

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Board, Commission, and/or Committee Appointment Application

*Date:
*Council District:
*Last Name:
*First Name:
*Middle Initial:
*Street Address:
*City:
*Zipcode:
*Phone Number:
*Employer:
*Occupation:
*Email:
*Boards/Commissions/Committees Being Applied for:
Advisory Committee on Urban Forest Management
Board of Review
Zoning Board of Appeals
Public Works Board
Joint CATV
Parks Board
Economic Development Commission
Redevelopment Authority
Plan Commission
Housing Authority
Library Board
Police & Fire Commission
Joint Rock Lake Committee
Ethics Board (Inquire for Specific Requirements)
*Current Board/Committee/Commission Service:
*Qualifications for Appointment:
*Education & Work Experience:
*Public Service and/or Civic Involvement/Background:
*Do you reside in the City of Lake Mills?:
Yes
No
*Do you hold an elected or appointed public position or office?:
Yes
No
If "Yes", what position or office?:
*How did you learn of this vacancy?:
City Website
Council/Board/Committee Member
City Employee
Community Agency
Newspaper
Other
*Enter your full name to serve as an electronic signature:


* - denotes required field