Carroll County Board of Supervisors and Related Agencies Committee/Board Appointments

First Name

Last Name

Street Address

City

State

Zip Code

Phone Number

Email Address

CONFIRM Email Address

District you reside in: *

Pipers Gap

Pine Creek

Fancy Gap

Laurel Fork

Sulphur Springs

Please write in the Committee or Board Name in the blank area that you wish to be considered as a candidate.

	you must have at least one item
Committee/Board Name:	you must have at least one item
Committee Board Name:	you must have at least one item
Committee Board Name:	you must have at least one item
Committee Board Name:	you must have at least one item

What experience do you have that may contribute to the activities if you serve as a member?

What experience do you have that would assist this committee?

Those Carroll County citizens interested in being considered for the above appointment or appointments, please submit this form to complete.

Form applications will be taken until filled.

You may contact the County Administrator's Office at 276-730-3001 for more information.

THANK YOU FOR YOUR INTEREST IN SERVING THE COMMUNITY!