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2. Town of Colchester, Vermont Volunteer Board/Commission Application
   Please fill out a separate application for each board/commission to which you wish to apply.
4. Required: Prior to submission of this application please read:
   The Colchester Code of Ethics Policy
6. Name*
8. Address*
10. Email *
11. Daytime Phone *
13. Board members must be residents of Colchester. Please check to confirm.*

    1. I am a Colchester Resident
15. Board/Commission to which you are applying:*
    -- Select One --Board of EthicsCemetery Advisory CommitteeConservation Commission Development Review BoardPlanning CommissionRecreation Advisory BoardOther
17. How did you learn about this Board/Commission? *
    -- Select One --A board / commission member Word of mouthColchester SunTown websiteFront Porch Forum Other
19. Have you attended any meetings of this board / commission in the six months prior to appointment?*

    1. Yes
    2. No

    (Potential appointees must attend one meeting in the three months prior to being appointed.)
21. Based on your understanding of the Code of Ethics Policy (link at top of page) would your employment or personal investments create a conflict of interest that might preclude your participation in this board's / commission's business or activities? *

    1. Yes
    2. No
23. If yes, briefly explain:
25. Are you in a leadership role, have a significant ongoing relationship, provide or direct funding, resources or volunteer time to, or have influence with any organization, public or private, which might be expected to have any business, financial or policy issues with the Town of Colchester?*

    1. Yes
    2. No
27. If yes, name the organizations and explain your involvement.
29. Do you provide goods or services that this Board, Commission, or the Town staff supporting this board currently use? *

    1. Yes
    2. No
31. If yes, briefly explain.
33. Do you provide any goods or services to the public related to this board / commission?*

    1. Yes
    2. No
35. If yes, briefly explain.
37. By checking the box below you confirm that you read the Code of Ethics policy and also understand that you cannot use the name of the Board or Commission in any business or representation before the Town unless it pertains to an issue the Board/Commission has formally taken up and voted on.*

    1. I so confirm.
39. Are you familiar with the governing rules under which this board / commission operates? *

    1. Yes
    2. No
41. Briefly, what qualities, experience, training and/or skills will you bring to this board/commission? *
43. Please share your ideas related to the board / commission and the topics they are responsible for, including, but not limited to, issues you have engaged with or advocated for publicly.*
45. My availability allows me to attend at least 80% of the meetings of the board / commission for which I am applying.*

    1. Yes
    2. No
47. Optional: Upload a statement of interest or a personal resume.
49. Your name below affirms that the information provided is true to the best of your knowledge. *
51. Thank you for your interest in volunteering at the Town of Colchester!
53. Below for internal use only.
    Interview by Board / Commission: Date:_________ Intials:__________
55. Recommendation made to Selectboard by Board or Commission Chair: Date:__________ Intials:__________
57. Potential conflicts reviewed by supporting staff: Date:___________ Initials:__________
Leave This Blank:


59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit Submit and Print

* indicates a required field