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City of Northampton, Massachusetts
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Application for Appointment to Boards, Committees and Commissions

  1. Please return the completed form to: Mayor@northamptonma.gov or David J. Narkewicz, Mayor 210 Main Street, Northampton, MA 01060

  2. This information is optional and will be used for diversity purposes only. Complete it only if you wish to do so.

  3. This information is optional and will be used for diversity purposes only. Complete it only if you wish to do so.

  4. This information is optional and will be used for diversity purposes only. Complete it only if you wish to do so.

  5. Please indicate the boards and committees you have an interest serving on.

  6. The filing of this form does not guarantee my appointment. An application is kept on file for two (2) years; after that I must file a new application. Being appointed to a committee, board, or commission means that I am considered a Municipal Employee under MGL Chapter 268A and thereby subject to Conflict of Interest Law MGL Chapter 268A, Financial Disclosure Law MGL Chapter 268B, as well as Open Meeting Law MGL Chapter 39: Section 23B. I understand that I will take the conflict of interest test after being appointed and that I also must be sworn in by the City Clerk. I will contact the appointing authority with any questions about my service. Important: Once this form is submitted it becomes a public document, if there is information you do not want open to the public please do not include it on this form.

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