2. This application and all information contained herein is a public record. Public service opportunities are offered by the Town of Bartonville without regard to race, color, national origin, religion, sex, genetic information or disability
4. Date & Time
   Date & Time

   Date & Time
6. First Name*
7. Last Name*
9. Address1*
11. City*
12. State*
13. Zip*
15. Phone Number*
17. Email Address
19. Are you a registered voter*

    1. Yes
    2. No
20. Voter Registration Number
    To verify your voter registration number go to www.votedenton.com, voter information, voter lookup
22. Length of Residency in Bartonville*
24. In order to serve as an appointed official, you must be a resident of the Town for at least six (6) months. In order to serve on the Planning and Zoning Commission or Board of Adjustments, you must be a resident property owner of the Town for a least six months.
26. Please select which board(s) you are interested in. If more than one, prioritize your selections using the choice options below as applicable.
28. Choice 1*
    -- Select One --Planning & Zoning CommissionBoard of AdjustmentsCrime Control & Prevention DistrictCommunity Development Corporation
29. Choice 2
    -- Select One --Planning and Zoning CommissionBoard of AdjustmentCrime Control & Prevention DistrictCommunity Development Corporation
31. Choice 3
    -- Select One --Planning & Zoning CommissionBoard of AdjustmentCrime Control & Prevention DistrictCommunity Development Corporation
32. Choice 4
    -- Select One --Planning & Zoning CommissionBoard of AdjustmentCrime Control & Prevention DistrictCommunity Development Corporation
34. Occupation (if retired, indicate former occupation/profession)*
36. List any experience that qualifies you to serve in the position(s) sought:
38. Are you currently serving on a Board, Commissions, or other capacity?*

    1. Yes
    2. No
40. If yes, which
42. Have you served on a Board, Commission, or Committee before?*

    1. Yes
    2. No
44. If yes, which
46. Please list organization memberships and positions held
48. Please List Areas of Special Interest
50. References
Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit Submit and Print

* indicates a required field