Date of Application (mm/dd/yyy)*

(This application will be retained for one year).

Name*

Street Address*

Daytime Telephone*

Evening Telephone*

Email Address*

Fax Number

Mailing Address*

Occupation*

Employer*

Appointed Position Desired (check all that apply)

Planning and Zoning Commission Construction, Advisory and Appeals Board Canyon Economic Development Corporation (4B) Board of Adjustment Canyon Housing Authority

Board of City Development Main Street Advisory Board Library Board Parks, Open Space and Recreation Advisory Board

Describe your interest and qualifications for the position desired.*

Have you served on the City of Canyon Commission?*

Yes

No

Have you served on another City's Commission or Council?*

Yes

No

Have you served on a City of Canyon Board or Committee?*

Yes

No

Have you served on another City's Board or Committee?*

Yes

No

Have you served on the board of a homeowner's association?*

Yes

No

How long have you been a resident of Canyon?*

How long have you been a resident of Texas?*

I understand that appointments are solely at the discretion of the City Commission and that this application is not the only basis of candidate selection.

Signed

Date (mm/dd/yyyy)

You may also deliver or mail this form to:

City of Canyon
Attn: City Manager
301 16th Street
Canyon, Texas 79015