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2. Application for Appointment or Re-Appointment to Longmeadow Boards, Committees or Commissions
   To be qualified to serve on a board, committee or commission you must be a resident of the Town of Longmeadow and eligible to vote in Town elections.
4. First Name*
5. Last Name*
7. Address:*
9. Home Phone:
10. Work Phone:
11. Cell Phone:
13. Email Address:
15. Registered Voter in Longmeadow:*

    1. Yes
    2. No
16. Number of years living in Longmeadow:*
18. Please select the board, committee or commission you have interest serving on:

    1. Audit Committee
    2. Board of Assessors
    3. Board of Health
    4. Cable Advisory Committee
    5. Community Preservation Committee
    6. Conservation Commission
    7. Council on Aging Board of Directors

    1. Cultural Council
    2. Diversity Equity & Inclusion (DEI) Advisory Committee
    3. Energy & Sustainability Committee
    4. Finance Committee
    5. Historic District Commission
    6. Historical Commission
    7. Housing Authority (Tenant Member)

    1. Park & Recreation Commission
    2. Recycling Commission
    3. Town Meeting Rules Committee
    4. Tree Committee
    5. William Goldthwait Fund Trustees
    6. Zoning Board of Appeals
20. Other board, committee or commission of interest, please list:
21. For more information on the Boards, Committees and Commissions click this link:
    Description of the Boards, Committees and Commissions
23. Have you, or are you currently, on another Town board, committee or commission: *

    1. Yes
    2. No
24. If yes, please list the board, committee or commission:
26. List all local civic, non-profit or other organization that you and/or your immediate family belong to:
28. Please identify any possible conflicts of interests:
    The conflict of interest law seeks to prevent conflicts between private interests and public duties, foster integrity in public service, and promote the public's trust and confidence in that service.
29. For more information on the Conflict of Interest Law
    Click this link for a summary of the Conflict of Interest law
31. Do you have a working relationship with any members of the board, committee or commission you are applying for:
33. Current Employer:
34. Position Title:
36. Does you employment pertain to the board, committee or commission you are applying for, if yes, please explain:
38. Applicant Signature:*
39. Date:
41. Important Information:
    The filing of this form does not guarantee my appointment. An application is kept on file for one fiscal year (July 1 - June 30); after that I must file a new application. Being appointed to a board, committee or commission means that I am considered a Municipal Employee under MGL Chapter 268A and thereby subject to Conflict of Interest Law MGL Chapter 268A, Financial Disclosure Law MGL Chapter 268B, as well as Open Meeting Law MGL Chapter 39: Section 23B. I understand that I will take the conflict of interest test after being appointed and that I also must be sworn in by the Town Clerk. I will contact the appointing authority with any questions about my service. Important: Once this form is submitted it becomes a public document, if there is information you do not want open to the public please do not include it on this form.
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43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field