Citizens Advisory Committee Application and Background Check Form

*This form does not recognize the auto fill feature. To successfully submit this form, all required fields must be filled out.

Date

Name

Address

City

State

Zip Code

Phone

Experience and/or education in the area of interest

Time of day meeting availability

Committee/Area of Interest

By checking this box, I confirm that I am a permanent Mahoning County Resident *

Yes

Please be advised that all Citizen Advisory Committee applications will remain on file for a period of one year.