Board Member Application | Jefferson County Public Library System

Name *

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Phone *

Email *

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

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Business Name

Occupation/Profession

Business Address *

Address Line 1

Address Line 2

City

State

Zip Code

I have been a resident of Jefferson County since...

Please insert year.

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I am a registered voter: *

Yes
No

Do you currently serve on a local government board, elected or non-elected? *

Yes
No

I am able to attend a 6:00 p.m. meeting, typically the 2nd Thursday of every other month: *

Yes
No

Please describe any qualifications [work experience, education, attributes, skills/training] that you feel would provide positive input to the work of the library board. *

Please indicate those areas in which your knowledge would be of benefit to the library board: *

Would you be interested in being an officer of the county board? If yes, which one(s) *

Please describe any former or current public service activities and accomplishments in the community [school groups, service clubs, other boards or commissions]. *

Please explain why you are interested in becoming a library board member.

Please discuss briefly the goals and directions that should be important to this Board. *

What do you see as the library’s role in the future? *

One thing you think the library currently does very well: *

One thing that could be done to make library service even better is: *

Any additional comments

Signature *

Clear Signature

Jefferson County Public LibraryBoard Member Application

Jefferson County Public Library
Board Member Application