Board or Commission Application

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Louisville Metro Boards and Commissions Application Form

Information provided on this form will be a public record subject to free and open examination by any person under the Kentucky Open Records Act.

Name:
* * * * *

Primary Phone
At least one phone number is required. The selected Primary phone must be filled in below.

Home Phone

Business Phone

Cell Phone

E-mail

*Street:

CityStateZip Code

Employer *

Profession/Occupation

Interests		PC users: To select multiple Interests, click each one as you hold down the Ctrl key. MAC users: To select multiple Interests, click each one as you hold down the Shift key.
Which Boards you would like to apply for?
Volunteer Activities
Past Service on City and County Boards and Commissions?
If Yes, Please List

Please answer the following questions. If you answer yes, please include relevant details (i.e. position, company, address, dates, etc.) in the Additional Notes section below.

Are you employed by Louisville Metro Government?
Do you or a member of your immediate family have ownership interest in any company that does business with Louisville Metro Government?
Do you or a member of your immediate family have ownership interest in any property that is the subject of a condemnation proceeding, planning and zoning proceeding or any other administrative or court proceeding in which Louisville Metro Government or its agencies are interested parties?
Do you have any contract or matter pending before any Louisville Metro Government agency?
Have you ever been sued by the former City of Louisville, Jefferson County or Louisville Metro Government?
Have you ever been convicted of a felony offense?

Additional Notes

Some boards and commissions require membership to be racially, politically or geographically proportionate to the general public. Please complete the information requested below.

*Race

*Gender

*Date of Birth

*
Use Format: MM/DD/YYYY*

*Party Registration

Louisville Metro Council District