Citizens Request for Appointment or Re-Appointment to a Board of Committee

2. First Name

3. Last Name

5. Address

6. Email Address

8. Phone Number (Home)

9. Phone Number (Cell)

11. Committee or Board of Interest*

13. Present Business Affiliation and Work

15. Business Experience, Education or Special Training

17. Town Office Held (in Ipswich or elsewhere)

19. Resume/Cover Letter Upload (optional)

    If you would like your employment and/or experience to be considered in your appointment request, please attach here.

21. The filling out of this form in no way assures appointment. All committee vacancies will be filled by citizens deemed most qualified to serve in a particular capacity. It would be most helpful if particular fields (such as finance, law engineering, etc) would be emphasized on this form, so that selections may be made on the best possible evaluation of interests and special qualifications. Please attach resume and cover letter with additional information.

    The filling out of this form in no way assures appointment. All committee vacancies will be filled by citizens deemed most qualified to serve in a particular capacity. It would be most helpful if particular fields (such as finance, law engineering, etc) would be emphasized on this form, so that selections may be made on the best possible evaluation of interests and special qualifications. Please attach resume and cover letter with additional information.

23. Signature*

24. Date*

26. Please return to the Town Manager’s office or by email to leahn@ipswichma.gov

    Please return to the Town Manager’s office or by email to leahn@ipswichma.gov

28. Date Recieved

29. Current Vacancy?
    -- Select One --YesNoReappointment RequestOther

30. Appointed By
    -- Select One --Town ManagerSelect BoardOther

32. Date of SB Agenda

33. Date of Town Manager Meeting

35. Appointed?

    1. Yes
    2. No
    3. Other

36. Appointment Date

37. Term Length

38. Limitations

40. Notes

Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field