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Board, Commission and Committee Application for Appointment

This application form will be the only information submitted to City Council when considering appointments.

Name*
Address*
City*
Province*
Postal code (no spaces)*
Phone number (home)
Phone number (work)
Fax number
Email address
Occupation
Which committee are you interested in?*
What do you believe is the role of the committee you identified above?
How can you contribute to the committee you identified above?
Is there another committee you are interested in? (please indicate)
What do you believe is the role of the second committee you identified?
How can you contribute to the second committee you identified?
List your skills, experience and other qualifications
Applicants may be requested to meet with representatives of City Council regarding their application. Contact information of successful applicants may be included in the City of Regina Boards, Committees and Commissions Book. This book is released publicly. Do you give the City of Regina permission to publish your contact information?*
Yes
No
Equity and Diversity: Declaration of membership in the categories below is voluntary. The information will be used to help ensure the appointments reflect the diversity of Regina's population
 
Aboriginal ancestry
Yes
No
Visible minority
Yes
No
Female
Yes
No
Person with a disability
Yes
No
Paratransit passenger
Yes
No
Under 30 years of age
Yes
No

All fields marked with an asterisk (*) are mandatory.