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Boards/Committees/Commissions Application Form

Profile

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Optional

The City strives to have a variety of people serving on its committees.

The following information is optional, but would be helpful to us in achieving our goal of balance.

 

Consent to Release Private Date

Below you will find a copy of the Minnesota State Statute that explains what data furnished by you are considered public and private. By completing the information below you will authorize the City of Moorhead to release the following private data upon request. Please check all that may be made public.

You must choose at least one phone number or e-mail address to be made public.

Contact Type Contact Information
Select atleast one.

MINNESOTA STATUTES 2010
13.601 ELECTED AND APPOINTED OFFICIALS

Applicants for appointment

  1. Data about applicants for appointment to a public body collected by a government entity as a result of the applicant's application for appointment to the public body are private data on individuals except that the following are public:
    1. name;
    2. city of residence, except when the appointment has a residency requirement that requires the entire address to be public;
    3. education and training;
    4. employment history;
    5. volunteer work;
    6. awards and honors;
    7. prior government service;
    8. any data required to be provided or that are voluntarily provided in an application for appointment to a multimember agency pursuant to section 15.0597; and
    9. veteran status.
  2. Once an individual is appointed to a public body, the following additional items of data are public:
    1. residential address;
    2. either a telephone number or electronic mail address where the appointee can be reached, or both at the request of the appointee;
    3. first and last dates of service on the public body;
    4. the existence and status of any complaints or charges against an appointee; and
    5. upon completion of an investigation of a complaint or charge against an appointee, the final investigative report is public, unless access to the data would jeopardize an active investigation.
  3. Notwithstanding paragraph (b), any electronic mail address or telephone number provided by a public body for use by an appointee shall be public. An appointee may use an electronic mail address or telephone number provided by the public body as the designated electronic mail address or telephone number at which the appointee can be reached.

Applications will be kept on file for two (2) years after date of submittal.