2. Title*

   1. Ms.

   1. Mrs.

   1. Mr.
4. Last Name*
5. First Name*
7. Address*
8. City*
9. Zip*
11. Primary Phone Number*
    000-000-0000
12. Secondary Phone Number
    000-000-0000
13. Email*
15. Most board members shall be qualified voters of the City of Irving and have resided in the City for not less than one year immediately prior to the date of appointment.
17. 1. Are you registered to vote in Irving?*

    1. Yes
    2. No
18. 2. How long have you been a resident in Irving?*
19. 3. What district do you live in?
    -- Select One --134567
21. 4. Are you now or have you ever served as a member on any Irving board or commission? If yes, list board(s) and year served.*
23. 5. List any civic or community activities you have been involved with.
25. 6. List any experiences (paid or unpaid) or qualifications that directly relate to the board(s) you are interested in.
27. 7. List current place of employment or business affiliation. Include self-employed, retired, etc.*
29. 8. What is your work experience?
31. Enter your first, second and third choice to indicate which board or committee you are interested in.
33. First Choice*
    -- Select One --Dallas County Flood Control DistrictDallas County Utility Reclamation District (DCURD)Irving Flood Control District, Section IIrving Flood Control District, Section III
34. Second Choice
    -- Select One --Dallas County Flood Control District, No. 1Dallas County Utility Reclamation District (DCURD)Irving Flood Control District, Section IIrving Flood Control District, Section III
35. Third Choice
    -- Select One --Dallas County Flood Control District, No. 1Dallas County Utility Reclamation District (DCURD)Irving Flood Control District, Section IIrving Flood Control District, Section III
37. Section 552.024 of the Texas Public Information Act provides that any appointed official of a government body shall choose whether to allow public access to the information in custody of the government body that relates to the person's home address or telephone number.
38. Allow public access to my address and phone number*
    -- Select One --YesNo
40. Section 552.137 provides that the email address of a member of the public that is provided for the purpose of communication electronically with a government body is confidential and not subject to disclosure.
41. Allow public access to my email address*
    -- Select One --YesNo
43. Your application will be kept on file with the City Secretary's Office for one year. If you have any questions please call (972) 721-2493.
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45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit Submit and Print

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