Form Center

2. Personal Information

   * Required Fields

4. First Name*
5. Last Name*
7. Home Address*

   Home address is required due to residency requirements for select City of Longview boards and commissions.

9. City*
10. State*
11. Zip Code*
13. Mailing Address (if different than home address)
15. City
16. State
17. Zip Code
19. Primary Phone*
20. Secondary Phone
21. Email Address*
23. Business Information
25. Occupation*
27. Business Name
28. Business Address
30. Applicant Information
32. Council Appointed Boards and Committees*

    I am applying to serve on the following boards and committees. Please check all that apply.

    1. Animal Shelter Advisory Committee
    2. Construction Advisory and Appeals Board
    3. Cultural Activities Advisory Commission
    4. Emergency Medical Services Advisory Board
    5. Housing & Community Development Advisory Commission
    6. Longview Historic Preservation Commission
    7. Parks and Recreation Advisory Board

    1. Partners in Prevention Steering Committee
    2. Planning and Zoning Commission
    3. Public Transportation Advisory Board
    4. Senior Advisory Committee
    5. Walk of Honor Task Force
    6. Zoning Board of Adjustment
    7. Any Board or Task Force
34. Longview Historic Preservation Commission Only

    In accordance with the Texas Historical Commission guidelines, the Longview Historic Preservation Commission has specific requirements for committee members. I am applying to serve the following place: (If not applying for Historic Preservation Commission, please skip to the next question)

    1. An architect, planner, or representative of a design profession
    2. A historian or someone knowledgeable in local history.
    3. A licensed real estate broker

    1. An attorney.
    2. An owner of a Historic Landmark or an owner of a property in a Historic Overlay District
    3. Member at Large (2 positions)
36. Your Length of Residency in Longview*
38. Have you ever served on other Boards, Commissions, or Committees?*

    1. Yes
    2. No
40. If yes, on which boards and commissions have your served and for how long?
42. Why are you interested in serving on this board?
44. What will make you a good board member, including any special knowledge, education, or experience?
46. Please list two references with their contact information.
48. Agreement: Please Read Carefully*

    I understand that there are requirements for making public any conflicts of interest I may have in service with this board. I understand that in compliance with Chapter 552, Vernon's Texas Codes Annotated, (Open Records Law), information provided on this application may be available to the public upon request and will be kept on file for at least two years. I understand that the board I am applying for has a 75% attendance requirement and I will be subject to being removed for excessive absences.

    1. Yes
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit Submit and Print

* indicates a required field