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2. Thank you for your interest in applying for a Delta County Board position. When filling out this application, please provide comprehensive information. You don't need to create an account to apply.

   Please note that the details you provide here are considered public records according to Colorado Public Records Law. Any information submitted on this volunteer service application will be available for public inspection. If you're a Delta County resident aged 18 or older, and are willing to contribute your time and expertise to the community, kindly complete and submit this form.

   In the event your application isn't initially chosen, it will be kept on file in the Clerk to the Board of County Commissioners' Office for two years. It may be reviewed and considered by the Commissioners when making appointments during this time.

4. Application Date*
   Application Date
6. First Name*
7. Last Name*
9. Physical Address*
10. Mailing Address, (if different)
12. City*
13. State*
14. Zip*
16. Phone Number*
17. Email*
19. How long have you lived in Delta County*
20. Current job*
22. District where you live*

    Select only one District

    1. District 1 (Delta area)
    2. District 2 (Cedaredge and Orchard City area)
    3. District 3 (Hotchkiss, Paonia, Crawford area)
24. Board you are applying for*
    -- Select One --Blake Field Advisory BoardBoard of AdjustmentsBoard of HealthCSU Extension Tri-River Advisory CommitteeCemetery Advisory Board (Cedaredge)Cemetery Advisory Board (Cory)Cemetery Advisory Board (Crawford)Cemetery Advisory Board (Eckert)Cemetery Advisory Board (Hotchkiss)Cemetery Advisory Board (Paonia)Community Services Block Grant Advisory BoardFair BoardHistoric Landmarks BoardLibrary District BoardPlanning CommissionTourism CabinetYouth Shooting Sports Advisory Board
25. Will you be able to attend one Board meeting each month, and attend additional committee meetings each month?*

    1. Yes
    2. No
27. Why are you interested in serving on this Board or Commission?*
29. Education*

    List your highest level of education, including name, city and state of educational institution. Please also include what degree you earned, if applicable, and the year of graduation.

31. Current employment*

    Current employer or if retired, name of previous employer. Please include address, telephone number, how long in position, and job title.

33. Tell us about yourself. Also, please describe any volunteer or community activities in which you are currently involved.*
35. References*

    Please provide three personal or professional references, along with type of relationship, years you've known this person, and their phone number.

37. Electronic signature*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit Submit and Print

* indicates a required field