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Board, Commission, Committee & Special Service District Application & Certification Form

  1. Instructions: Complete and sign this form and return it to Grand County Council Office, 125 E. Center St., Moab, UT 84532; fax: 435-259-2574; or

  2. (residency is required for all Boards; some District boards require residency within the District, which may not include Moab City limits; two years’ residency prior to assuming board membership is required for Planning Commission)

  3. (applicable for Historical Preservation Commission and Housing Authority of Southeastern Utah)

  4. I have read, and I certify, that all the information on this form is true and correct and I meet the requirements listed above. Furthermore, if appointed, I agree to faithfully attend the meetings and adhere to the State laws, County ordinances, and adopted Bylaws that govern the Board or Commission on which I am appointed to serve. Additionally, I have read the County’s Conflict of Interest Ordinance (No. 462, November 2007) and do not have any inherent conflicts in serving on the Board or Commission to which I have applied. I agree to abide by this Ordinance.

  5. Applicant Certification*

    I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.

  6. Leave This Blank:

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