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City of Gastonia

candiceo@cityofgastonia.com

PO Box 1748 Gastonia, NC 28053

704-866-6720

Citizen Committee Application for Appointment

The City of Gastonia appreciates your interest in serving on a committee and requests that you complete the following application. This application requests general information based on your interest in applying for a committee for the City of Gastonia.

Applicant Name

Home Address

Mailing Address (If different than above)

Preferred method of Contact (check all that apply)

Do you reside within the City Limits of Gastonia?

Length of residence in Gastonia

In order to consider this application and provide balance and diversity to the various Boards, the City of Gastonia requests that the following information be voluntarily provided:

Date of Birth

Gender

Race

Questionnaire

Please indicate the committee(s) you are interested in serving on:

Prior Public Service

Additional Information

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