Application To Serve on Board/Commission/Committee
Please fill out this application for consideration to serve on a Board/Commission/Committee with Franklin County.
logo to use transparent

Office of the Clerk to the Board of Supervisors
1255 Franklin Street, Suite 111 • Rocky Mount, VA  24151

PHONE:  540-483-3032 • FAX: 540-483-6647
Board/Commission/Committee Applying For
Board/Commission/Committee Applying For
Education (Degree's and Graduation Dates)
Memberships in Fraternal, Business, Church and/or Social Groups
Public, Civic and Charitable Office and/or other activities or interests
Reason(s) for wishing to serve on this Board/Commission/Committee
If you wish to add more information, you may attach a document or file here. If not, please sign and SUBMIT.
If you wish to add more information, you may attach a document or file here. If not, please sign and SUBMIT.
*By typing your name, you are certifying that you have read and agree with the following statement in its entirety. I agree that my typed name on this document is the legally binding equivalent to my handwritten signature. I will not, at any time in the future, repudiate the meaning of this signature or claim that this signature is not legally binding.

*By typing your name, you are certifying that you have read and agree with the following statement in its entirety.

I agree that my typed name on this document is the legally binding equivalent to my handwritten signature. I will not, at any time in the future, repudiate the meaning of this signature or claim that this signature is not legally binding.

NOTE: The information provided on this application may be released to the public upon request.