Forms • Daytona Beach, FL • CivicEngage

Select the board or commission membership of interest

Please note that, pursuant to Florida Statutes,
Chapter 119, this application and any other
related written or electronic communication
shall become a public record and is subject
to public disclosure.

Completed applications will be kept active for
a period of one (1) year from the date received
in the Office of the City Clerk.

All persons seeking re-appointment must also
submit an application to be considered.

Per Resolution No. 2022-01:
All members of City boards appointed by the City Commission shall attend 4 hours of training annually that includes the topics of training required of elected municipal officers by Section 112.3142, Florida Statues.

	Affordable Housing Advisory Committee *Additional Information Required below*
	Beachside Redevelopment Board Requires Annual Financial Disclosure
	Beautification/Tree Advisory Board
	Board of Adjustment Requires Annual Financial Disclosure
	Board of Building Codes Requires Annual Financial Disclosure
	Code Enforcement Board Requires Annual Financial Disclosure
	Community Relations Council
	Daytona Beach Racing & Recreation Facilities Commission Requires Annual Financial Disclosure
	Downtown Development Authority Requires Annual Financial Disclosure
	Downtown Redevelopment Board Requires Annual Financial Disclosure
	Economic Development Advisory Board
	Enterprise Zone Development Agency
	Historic Preservation Board Requires Annual Financial Disclosure

	Housing Authority Commission
	Mayor's Alliance of Persons with Disabilities
	Midtown Redevelopment Board Requires Annual Financial Disclosure
	Nuisance Abatement Board Requires Annual Financial Disclosure
	Parks and Recreation Advisory Board
	Peabody Auditorium Advisory Board
	Personnel Board
	Planning Board Requires Annual Financial Disclosure
	Police & Fire Pension Fund Board Requires Annual Financial Disclosure
	Public Arts Advisory Board
	Citizen's Police Review Board
	Other - List Board Below

PERSONAL INFORMATION

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Title*

First Name*

Last Name*

Address*

City*

State*

Zip Code*

Home Phone*

Cell Phone*

Race - (*this information is requested pursuant to Section 760.80 Florida Statutes)*

Sex*

Date of Birth*

Email Address*

Are you a registered voter in the City?*

Zone*

Is your primary residence in Daytona Beach?*

Are you a U.S. citizen?*

Do you require special accommodations?*

Yes

No

If you require special accommodation, please list.

Business Information

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Do you own property in Daytona Beach?*

Yes

No

Do you own a business in Daytona Beach?*

Yes

No

Business Address

Business Phone

Are you employed in Daytona Beach?*

Yes

No

Employer Name and Address*

Occupation*

EDUCATION/EXPERIENCE

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List all Professional Degrees, Licenses and Certificates*

Select all areas of special knowledge or expertise applicable to the board opening you are applying for (see listing below)*

How does your special knowledge/expertise pertain to the board opening you are applying for?

Additional Information (Civic Activities, memberships, etc.

Why are you interested in serving on a City Board or Commission?

Have you attended one or more meetings of the board for which you are applying?*

Yes

No

Do you currently serve, or have you ever served on a board?*

Yes

No

If So, which board?

How many years have you served?

If this is a reappointment, how long have you served on this board?

Other Board

I understand the responsibilities associated with being a board member, that some boards require an Annual Financial Disclosure (boards indicated above), and I have adequate time to serve if appointed.*

Yes

No

*I understand that membership in the Affordable Housing Advisory Committee requires qualification in one of the eleven (11) categories listed below.*

Yes

No

***If you are applying for the Affordable Housing Advisory Committee (AHAC) you must complete this section. If you are NOT applying for AHAC, select N/A below.***

Governed by Ordinance No. 93-37, Ordinance No. 96-259, Ordinance No. 08-112, Ordinance 19-39, and F.S. 420.9072(9), amended by F.S. 420.9076 (2), states that the Advisory Committee shall consist of at least 8 but not more than 11 committee members who are citizens recommended by the City Manager, the Mayor, or any City Commissioner and appointed by resolution of the City Commission for a two (2) year term. Effective October 1, 2020 the committee must consist of one locally elected official from each county or municipality participating in the State Housing Initiatives Partnership Program (CC) and the committee must consist of one representative from at least six of the following categories, actively engaged and specifically in connection with affordable housing. Pursuant to s. 163.3174, if the local planning agency is comprised of the governing board of the county or municipality, the governing board may appoint a designee who is knowledgeable in the local planning process to satisfy the necessary category. *

I understand The City of Daytona Beach may conduct a background check including a criminal history and code violations check and that the information so obtained will be maintained on file with my application. *

Yes

No

* indicates required fields.

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