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Please check the following Boards or Commissions for which you are interested in being considered for appointment. (If completing the form online, please click on the blue box beside the Boards or Commissions you are interested in.)

( ) Indicates length of terms in years

Middlesex County Boards and Commissions

Comprehensive Services (Family Assessment & Planning Team and/or Community Policy & Management Team) – Parent Representatives
Recreation Committee
Economic Development & Tourism Advisory Committee
Broadband Authority
Water Authority
Keep Middlesex Beautiful/Litter Committee
Board of Equalization

Regional Boards and Commissions

Bay Consortium Workforce Investment Board
Chesapeake Bay Agency on Aging, Inc.
Middle Peninsula-Northern Neck Community Services Board
Middle Peninsula Planning District Commission

Rappahannock Community College
Tidewater Resource, Conservation & Development Council
Tidewater Soil and Water Conservation District

Interest in serving in other areas. Please list:

Electronic Signature Agreement

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.

I agree.

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Application to County Boards, Committees, Commissions and Authorities

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