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CITIZEN APPOINTMENT APPLICATION FORM <br /> The following board, committee, commission, or agency of the City <br /> will soon become vacant. This is a Common Council appointment <br /> for the following term: <br /> Name, description and authority of <br /> 1. <br /> Last Name First Name Middle Intital <br /> Street Address <br /> City State Zip Code <br /> Telephone Number (Home) (Work) <br /> 2 . Years of residency within the City of South Bend: <br /> 3 . Political party if applicable to the appointment: <br /> 4. Please state the qualifications as to why you believe <br /> you would be a qualified candidate for this citizen appointment: <br /> 5. Please provide a summary of your educational background <br /> including a listing of degress and areas of institutions of <br /> higher learning: <br />