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Diversity, Equity and Inclusion Community Task Force

  1. Applicant Information

  2. If married, spouse's first and last name

  3. Board Selection and Qualifications

  4. 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.

  5. Committee-Qualifications

  6. I have read the above qualifications to serve on a city commission or board.*

  7. 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.

  8. Appointee-restrictions

  9. By typing in your name above, you confirm your awareness and agreement to follow the above listed restrictions on appointees.

  10. Leave This Blank:

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