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Application for Appointment to Committee or Board
(* indicates required field)








I wish to be appointed to the following board, committee, authority or special activity of the Highlands County Board of County Commissioners:

  Affordable Housing Advisory Committee
  Board of Adjustment / Planning & Zoning Commission
  Children's Service Council
  Construction Licensing, Enforcement and Appeals Board
  Dangerous Dog Hearing Board
  Extension Advisory Council
  Health Facilities Authority
  Heartland Workforce Investment Board, Inc.
  Highlands County Citizen Advisory Task Force
  Historic Preservation Commission
  Hospital District Board
  Industrial Development Authority / Economic Development Commission
  Insurance Committee
  Lake Istokpoga Management Committee
  Local Mitigation Strategy Workshop
  Natural Resources Advisory Commission
  Public Safety Coordinating Council
  Recreation and Parks Advisory Committee
  Tourist Development Council
  Veteran Services Advisory Board

As a*:   Regular Member   Alternate    Advisory Only

Current Employment Experience*:

Previous Employment Experience*:

Education / Special Training*:

Activities & Interests*:

List any boards or committees to which you are currently appointed, elected offices held, or law enforcement positions held:

Are you related to any County employee or County Commissioners:   Yes    No

Name of Relative:    Relation:


The Highlands County Board of County Commissioners has an adopted Code of Conduct for persons serving on committees, boards, and panels appointed by the Highlands County Board of County Commissioners. Part II, number 10, of the Code of Conduct prohibits Being convicted of a felony or first degree misdemeanor as defined by Florida Statutes or any other crime involving moral turpitude.

Have you ever been convicted of a crime that would preclude you from serving on a committee, board or panel?   Yes    No

Highlands County strives to maintain diversity in membership on its advisory committees and boards. Although strictly optional for applicant, the following information is needed to meet reporting requirements and attain those goals.

Gender:   Male   Female

Disable:   No   Yes


 Black or African American
 Hispanic or Latino
 American Indian or Alaska Native
 Native Hawaiian or Other Pacific Islander

   Upon checking this box, I electronically sign my application and certify that all statements and information provided in the application are true and to the best of my knowledge.  It is the applicants responsibility to keep the information on this application current.  To advise the County of any changes please contact Michelle Drake by phone (863) 402-6517 or by email: