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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.
23. Signature*
24. Date*
26. 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 TM 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