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Boards and Commissions Application Form
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Applicant Information
First Name
*
Last Name
*
Address
*
City
*
State
*
Zip Code
*
Home / Cell Phone
*
Email Address
*
Length of Bentonville Residency
*
Employer
*
Occupation
*
Business Phone
*
References
Please provide 2 references
Name
Email Address
Address
City
State
Zip Code
Phone Number
Name
Email Address
Address
City
State
Zip Code
Phone Number
Fax Number
Board Selection and Qualifications
Select all commissions and boards for which you would like to be considered:
*
Advertising & Promotion Commission
Bentonville Municipal Airport Advisory Board
Board of Adjustment
Diversity, Equity and Inclusion ((DEI) Community Task Force
Library Advisory Board
NACA Board
NWA International Airport Authority Board of Directors
Ozark Regional Transit Authority
Parks and Recreation Advisory Board
Planning Commission
Public Art Advisory Committee
Tree & Landscape Advisory Committee
Utility Board
Short -term Rental Work Group
1. What are your qualifications for serving on this commission or board, including education and subject matter expertise?
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2. Why would you like to be considered for appointment to this commission or board?
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3. What do you hope to be able to contribute?
*
Qualifications for Serving
Please read the Qualifications for Serving provided below. These are the general qualifications to serve on any board or commission of the City of Bentonville.
I have read the above qualifications to serve on a city commission or board.
*
Yes
No
Restrictions on Appointees
Please read the Restrictions on Appointees provided below. Then type in your name and date to confirm that you are aware of and, if appointed, agree to the following rules.
Agreement to Abide by Restrictions on Appointees
*
By typing in your name above, you confirm your awareness and agreement to follow the above listed restrictions on appointees.
Date
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Date
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