Thank you for your interest in serving on the Yorkwood District Board. Please complete the following application in full. All information will remain confidential and will be used solely for the purpose of evaluating applicants for board membership.

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Full Name

(First and Last)

Address

Address Line 1

Address Line 2

City

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Zip Code

Email

Phone

Date of Birth

Do you rent or own your place of residence?

• Rent
• Own

Have you ever been convicted of a felony?

• Yes
• No

(A prior conviction does not automatically disqualify you from consideration.)

If yes, please explain.

If Email been

Why do you want to serve on the Yorkwood District Board?

Today's Date

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