Citizen Board Application Form

2. Pitkin County seeks to create an inclusive and accessible process for individuals who wish to serve on citizen boards. We strive to ensure that board members are committed to our values around health and the environment, inclusion and equity, quality data and lived experiences, and are representative of the communities we serve.

4. Select the Board, Commission, or Committee applying for*
   -- Select One --Select OneAnimal ShelterBoard of AdjustmentBoard of AppealsBoard of HealthCitizen Grant Review CommitteeConflict Committee PoolElection CommissionFinancial Advisory BoardHousing AuthorityLibrary BoardOpen Space and TrailsPlanning & ZoningRedstone Historic Preservation CommitteeRetirement BoardSenior Services CouncilTelecommunications Advisory BoardWeed Advisory Board

6. Personal Information

8. First Name*

9. Last Name*

11. Physical Address*

13. Mailing Address*

15. City*

16. State*

17. Zip*

19. Home Phone Number*

21. Business Address*

23. Business Phone Number*

25. Occupation*

27. Email Address*

29. Residency Information

31. Length of Residency in Pitkin County*

33. Education and Hobbies

35. High School

37. College

39. Trade or Business School

41. Hobbies

43. Organization Membership Information

45. Are you currently serving on other Boards, Commissions, or Committees?*

    1. Yes
    2. No

47. If yes, which

49. Have you served on a Board, Commission, or Committee before?*

    1. Yes
    2. No

51. If yes, which

53. Please list organization memberships and positions held

55. Please List Areas of Special Interest

57. How did you hear about this opportunity?

59. Please Attach Your Resume as a pdf*

Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit Submit and Print

* indicates a required field