DELAWARE TOWNSHIP

CITIZEN LEADERSHIP FORM

I, _______________________, hereby apply to perform public service on the following municipal authorities, boards or commissions:

1. _________________________________________________

B. __________________________________________________

C. ___________________________________________________

Name: ______________________________________

City, State: ___________________________________

Zip: _________________________________________

Please list any:  education, prior volunteer experience, work related experience; or other civic involvement which could be of use to the authorities, boards or commissions which you listed above:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

**Personal Information Not Subject to Public Disclosure**

Primary Phone Number: ___________________________________

Address of Residence: _____________________________________

                                    _____________________________________

Email Address: ___________________________________________

**The information in this section is considered personal information, and therefore deemed confidential for the purpose of P.L. 1963, c. 73 (C.47:1A-11 et seq.) and P.L. 2001, c. 404 )C.47:1A-5 et al.).**