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Citizen Board Application Form

  1. Application for Appointment to City Board or Committee

  2. Applying For:*

  3. City Resident?*

  4. City Business Tax?

  5. Registered Voter?*

  6. Own Property in City?

  7. Enter the best phone number to contact you.

  8. Enter your business phone number

  9. Working Status

  10. Fla. Statute 760.80 requires the City of Lake Wales to maintain and report the following information:

  11. Race/Ethnicity*

  12. Gender*

  13. Physically Disabled*

  14. Applicant Initials

  15. Have you ever been convicted of a felony?*

  16. List 3 references who reside in the city:

  17. Enter phone number

  18. Enter phone number

  19. Enter phone number

  20. Contact City Clerk's Office to schedule appointment with board chairman and board support staff.

  21. Please type your name in the box provided

  22. Please enter date

  23. If the applicant is not appointed at the next City Commission meeting scheduled for the purpose of making appointments, this application will be retained on file for 6 months.

  24. Leave This Blank:

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