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2. 
4. Volunteer Interest Questionnaire
6. CONTACT INFORMATION
8. Full Name*
9. Email Address
11. Street Address, City, State, Zip
12. Primary Phone#
14. BOARD /COMMISSION /COMMITTEE INTEREST
16. Board/Commission/Committee Interest*

    1. Ephrata Borough Authority
    2. Ephrata Area Joint Authority
    3. Library Board
    4. Park & Recreation Board
    5. Planning Commission
    6. Police Chaplain

    1. Police Civil Service Commission
    2. Police Special Services Civilian
    3. Shade Tree Commission
    4. Youth Aid Panel
    5. Zoning Hearing Board
    6. Other
18. If Other please list
20. If interested in more than one, please indicate your preference below
22. BACKGROUND INFORMATION
24. Are you a resident of the Borough?*
    -- Select One --YesNo
25. How long have you lived in the Borough?*
    -- Select One --Less than 1 Year1-5 Years6-10 Years10+ Years
27. Do you own or operate a business within the Borough?*
    -- Select One --YesNo
29. If Yes, please specify the Business Name
31. Please describe any previous volunteer experience or community involvement
33. Do you have any professional or personal skills that may be useful to the Board/Commission/Committee?

    e.g., finance, law, planning, communication, education, public safety

35. Are you currently or have you previously served on any boards, commissions, or committees? If yes, please specify:
37. AVAILABILITY
39. How much time are you willing to dedicate to your role?

    1. 1-2 hours/month
    2. 3-5 hours/month
    3. More than 5 hours/month
41. Select your availability below:

    Borough's Business Hours = 8:00am to 4:30pm; Evening = 4:30pm-9:00pm

43. MONDAY

    1. Business Hours
    2. Evenings
44. TUESDAY

    1. Business Hours
    2. Evenings
45. WEDNESDAY

    1. Business Hours
    2. Evenings
47. THURSDAY

    1. Business Hours
    2. Evenings
48. FRIDAY

    1. Business Hours
    2. Evenings
50. Many Borough Boards and Commissions require multi-year commitment (typically 3-5 years). Are you willing and able to serve for the full length of a multi-year appointment?

    1. Yes
    2. No
52. ADDITIONAL INFORMATION
54. 1. Why are you interested in serving the Borough in this capacity?
56. 2. Do you have experience working in a collaborative or decision-making environment? If yes, please describe.
58. 3. Are you comfortable attending meetings, reviewing materials in advance, and participating actively in discussions?

    1. Yes
    2. No
60. 4. Board, Commission, and Committee members are expected to act in the best interest of the Borough and maintain confidentiality when dealing with sensitive information, matters or deliberations not intended for public disclosure. Do you agree to uphold these standards and maintain confidentiality as required?

    1. Yes
    2. No
62. 5. Do you have any other experiences, skills, or perspectives that you feel would be valuable for the Borough to know?
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64. 1. Receive an email copy of this form.
65. Email address

    This field is not part of the form submission.

66. Submit Submit and Print

* indicates a required field