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Burrillville Volunteer Application

Board or Committee Appointment Sought: (Check all that apply)

Please fill out the following form, and click on submit at the bottom of the page to deliver it electronically to the Office of the Town Clerk.  Be sure to fill out the form completely, or we will be unable to properly respond.

Choose from the following:
 Burrillville Extended Care
 Board of Assessment Review
 Budget Board
 Conservation Commission
 Housing Authority
 Industrial Foundations
 Juvenile Hearing Board
 Library Board of Trustees
 Narcotics Guidance Council
 Personnel Board
 Planning Board
 Recreation Commission
 Redevelopment Agency
 Sewer Commission
 Zoning Board
 Other Commission (Indicate Below)
Please provide the following information:
* indicates required information
Name
 *
Address:
 *
City:
 *
State:
 *
Zip:
 *
Phone:
 *
Alt Phone:
Fax:
Organization:
E-mail:
 *
Please indicate your reason(s) for seeking appointment to the above board(s) or committee(s):
Education, training or experience relevant to appointment sought, prior service on a town board, if any, and special skills, knowledge, talents, insights or point of view that you might offer to the board, commission or committee and any objectives you may have for the position:
Are you are registered voter in the Town of Burrillville?
All applications expire 24 months from submittal date, unless renewed by the applicant.

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Burrillville Town Hall: 105 Harrisville Main St. Harrisville, RI 02830
Phone: (401) 568-4300