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Citizen's Application for Appointment to a Dane County Committee, Commission, or Board

Please note:

  • You must be a resident of Dane County to request an appointment.
  • All fields marked with an asterisk (*) are required.
  • All information on this form is public record.

Personal Information

Last Name * First Name * Middle Initial
Street Address *
City * Zip Code *
Home Phone * Business Phone * Email *
Employer *
Occupation *
Business Address *
City * Zip Code *

Committees of interest to you *

Please select up to three committees to apply for *


What education or special training do you have which you feel particularly fits you for the appointment to this position? *

What work or other experience do you have which will be beneficial in carrying out the responsibilities of this position? *

Supervisory District * Referred by * If Other, please specify
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Affirmative Action Data

Race Age Disabled
Please specify type of disability

Conditions of Submittal

  • All information on this form is correct to the best of my knowledge.
  • All information on this form will become public record.
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