Putnam Citizen Participation Application

Citizen Participation Application Online Form

All Fields are Required

I wish to apply for Appointment to the:

I understand that if appointed, I will serve in a voluntary capacity on this advisory board.

Full Name

Phone Number

Address

Email Address

Occupation

Occupation Phone Number

Occupation Address

Are you a registered voter?

In what District do you reside?

How long have you lived in Putnam County?

Professional Qualifications

What would you hope to accomplish by your participation?

When are you NOT available for meetings?

By my entering my typed signature below, I certify that the information on this application is true and complete. I understand that false statements will be cause for denial of appointment. I also understand that, if appointed, the State of Florida may require me to file a financial disclosure with the Putnam County Supervisor of Elections within thirty (30) days of my appointment, and each year thereafter, covering my term of appointment.

**All Fields are Required**

All Fields are Required