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2. 
4. Date*
   Date
6. Name*
8. Address*
10. City*
    -- Select One --PittsburghSewickleyWexford
11. State*
    -- Select One --PA
12. Zip Code*
    -- Select One --150901514315237
14. Phone Number*
15. Alternate Phone Number
17. Email Address*
19. Position(s) for which you are applying:*

    1. Building Boards of Appeals
    2. Civil Service Commission
    3. Environmental Advisory Council
    4. Historical Committee
    5. McCandless/Franklin Park Ambulance Authority Board
    6. Northland Library Board

    1. Planning Commission
    2. Recreation Board
    3. Scholarship Selection Committee
    4. Technology Advisory Board
    5. Vacancy Board
    6. Zoning Hearing Board
21. Please explain why you want to serve in this position:*
23. Are you a current member of any other Borough Authority, Board, Commission or Advisory Committee:*

    1. Yes
    2. No
25. If yes, please state why you desire to join another committee:
27. Qualifications/Experience (Please attach a letter of interest and/or resume)*
29. Print Name:
31. Accept this as my electronic signature.

    1. Agree
35. Official Use Only
36. Date Received
37. Received By
38. Acknowledgement Sent
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40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

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