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Citizen Advisory Boards & Committees Application Form

  1. Select the Board or Committee applying for

    Choose all that apply

  2. Conflict of interest is defined as the participation in any activity, recommended action, or decision from which the individual has or could have the potential to receive personal gain, whether it be direct or indirect.

    In accordance with this definition, do you have any legal or equitable interest in any business, however organized, which could be construed as a conflict of interest?

  3. Are you currently serving on any other Scott County Citizen Advisory Committee/Board?

  4. Are you related to any Scott County Commissioner or to any member on the Committee/Board in which you are interested?

  5. Leave This Blank:

  6. This field is not part of the form submission.