2023 to 2024 CB4 Committee Membership Request Form
If you live, work, own a business or a property, or have some other significant interest in Community District 4, you are eligible to serve on the Board's committees as a Public Member.

This request form is for Public Members who would like to be considered for committee appointments.  Public members shall be appointed at the discretion of the Board Chairperson in September and January (midterm appointment).  Submission of this form does not guarantee your appointment. Term of appointment is for one (1) meeting year. Appointment letters will be sent by the District Office via email or by request to the mailing address below.

*NOTE* Your contact information will not be shared with the public. However, it may be shared with the Board and fellow committee members who would like to contact you. If you prefer not to share your information, please contact the District Manager.
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Email *
Today's Date *
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Full Name (First and Last) *
Mailing Address *
Phone Number *
Occupation and Employer *
Committees (Please select your committee preferences from the list below) *
Required
How many committees are you willing to serve on? (limited to three committees max) *
If you selected more than one committee, please indicate the order of your preference below. *
Experience (Indicate any relevant work experience and community involvement ) Please submit a current resume to bk04@cb.nyc.gov highlighting any additional experiences you have not already listed. *
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