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Secretary:
Shannon Stroud
(816) 630-0752
E-mail the Mayor or City Council
For printable PDF
application click here.


Application for Clay County/University of Missouri Extension Council

The City of Excelsior Springs is taking nominations for a representative to serve on the Clay County University of Missouri Extension Council. The term of service would start as of March 1, 2015 and extend through February, 2017.

Personal Information

Name

Date of Birth

Address

City
Zip

Home Phone Cell Phone

Email

Spouse/Partner


Employment Information

Employer


Address


City
State Zip

Business Phone
FAX

Email


Educational Background

High School
College

Post-secondary
Special Training

Community Activities (please list any organizations or groups you participate in and any leadership roles you have assumed)

Organizations
Offices or leadership positions

1.

2.


3.


4.









Have you served on the University of Missouri Extension Council in Clay County or any other County before?
Yes No

If yes, when and where?
County
When did you serve?

Why do you want to serve on the Clay County/University of Missouri Extension Council? What skills and expertise do you feel you can contribute to the organization?


Signature
Date