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Citizen Activity Form

  1. Use this form to apply to be appointed to a board, committee or commission.

  2. The Town of Amherst relies on the efforts of our volunteers. The Amherst Select Board keeps a file of
    residents who are interested in serving on any appointed committees, boards and commissions. To fill
    vacancies as they occur, this information will be used by the various appointing authorities: Select Board,
    Town Manager, and Moderator.

  3. I am applying to be appointed to:

  4. Applicant Information

  5. Reference Information

  6. Please do not list the Town Manager, the Moderator, or current members of the Select Board as any of your three references.

  7. Optional Information

  8. The following four questions are optional. The goal of the appointing authorities is to appoint qualified and interested Amherst residents who are broadly representative of the Town. Any information you provide in this section would aid us in that goal.

  9. Residence:

  10. Required: Please read the following and state that you understand and agree: The filing of this form does not guarantee my appointment. An application is kept on file for two (2) years; after that I must file a new Citizen Activity Form. Being appointed to a Town committee, board, or commission means that I am considered a Municipal Employee under MGL Chapter 268A and thereby subject to Conflict of Interest Law MGL Chapter 268A, Financial Disclosure Law MGL Chapter 268B, as well as Open Meeting Law MGL Chapter 39: Section 23B. I understand that I will take the conflict of interest test AFTER being appointed but BEFORE being sworn in by the Town Clerk. I will contact the appointing authority with any questions about my service.

  11. I have read, understand and agree to the above terms:*

  12. Leave This Blank:

  13. This field is not part of the form submission.