Application for Mayoral Appointment to a Board or Commission

Office of Boards and Commisions

Office of Boards and Commissions

OBC HOME

	About OBC
	Director's Biography
	How to Reach Us
	Ask the Director
	FOIA Requests
	FAQs

INFORMATION

	Application Form and Guide
	Boards & Commissions Lists
	Board Approval Requirements
	Financial Disclosure Requirements
	Occupational & Professional Licensing Boards
	Photo Gallery
	Responsibilities of Members of Boards & Commissions
	Stipends/Paying Boards

ONLINE SERVICE
REQUESTS

Application for Mayoral Appointment to a Board or Commission

Complete the form in full. Fields marked with * are required.
Allow for a three week processing time.
Provide draft language if applicable.

Requested By Outside U.S.

Prefix * First Name Initial * Last Name Suffix

* Address: WorkHomeOther

If work, enter company or organization:

* City:

* State: * Zip:

* Province:

* Postal Code:

* Country:

Add an Additional Address

* Address: WorkHomeOther

If work, enter company or organization:

* City:

* State: * Zip:

* Province:

* Postal Code:

* Country:

* Home Phone:

Work Phone: Cell:

Work phone format: xxx-xxx-xxxx ext12345

* Email:

Add an Additional Email

Email:

  Organization:

Secondary Address(optional)

Address:

Home Work

City:

State:

Zip:

Phone:

Home Work

Email:

Application for Appointment
* Board 1:
Board 2:
Board 3:
Other:

Personal Information

* Gender:

MaleFemale

* Date of Birth:

* Ethnicity:

Diversity:

Senior/Elder Citizen (60 years or older)

Young Adult(16 years to 24 years)

Person with Disabilities

Veteran of U.S Armed Forces

Gay, Lesbian, Bi-Sexual, Transgendered (GLBT)

Other

Education and general Qualification

* Did you Attend High Shool or receive a GED?			YesNo
Name of High School/GED:		School Location:
Did You Graduate?	YesNo	Last Year Attended:

* Did you Attend a College or post-secondary education?			YesNo
Name of College/University:		School Location:
Did You Graduate?	YesNo
Degree(s):		Major of Course:
Year:		Last Year Attended:

* Did you Attend a Graduate Postgraduate Program?			YesNo
Name of College/University:		School Location:
Did You Graduate?	YesNo
Degree(s):		Major of Course:
Year:		Last Year Attended:

Licenses Held (if applicable):

Special Skills and Qualifications:

Community Activities/Organizational Affiliations(current):

Declarations
* Are you a citizen of the United States?	YesNo
* Are you a Permanent Resident of the United States?	YesNo
* Are you registered to vote in the District of Columbia?	YesNo
* Are you a current employee of the U.S. government?	YesNo

* Are you a current employee of the District government?	YesNo
* Are you, or a family member, currently serving on board?	YesNo

* Have you ever had a professional/occupational license revoked, or suspended, as a result of desciplinary action?	YesNo
	If yes, please privde written details:
* Have you ever been convicted of, or pleaded guilty to, a crime?	YesNo
	If yes, provide written details:
* Is there anything in you background that might become an embarrassment to you if it were to become public?	YesNo
	If yes, provide written details:

Application Details
Comments:
Reference:
Resume: (Optional)

I certify that the facts and declarations contained in this application are true and correct to the best of my knowledge. I further authorize investigation of all statements contained herein and any personal references that I may include, or later provide, to obtain any and all pertinent information. I understand that providing false response may be cause to remove me from service on a board or comission, if appointed.