Online Forms

Town of Smyrna Committee Application

Project Assistance Board

The Project Assistance Program was created to provide financial assistance to citizens in the areas of utility services. The board consists of seven members including the Director of Utilities, the Police Department Community Services Coordinator and five members affiliated with benevolent organizations in the Smyrna / LaVergne area. Term of service is three (3) years.

The Project Assistance Board meets the second Tuesday of each month at 4:00pm at City Hall (315 South Lowry Street).

1

Date

 *

Date

2

Committee Requested

 *

Project Assistance Board

3

Name

 *

Name

4

Full Address (must live within Smyrna City Limits)

 *

Full Address (must live within Smyrna City Limits)

Street Address

City

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Zip Code

5

You will need to provide verification of your address by submitting a copy of your driver's license or other State-issued ID.

You will need to provide verification of your address by submitting a copy of your driver's license or other State-issued ID. Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

If you are unable to upload a file, here are other ways to submit a copy of your driver's license or State-issued ID:

• Submit via e-mail
• FAX to (615) 355-5715
• Deliver in person to City Hall (315 South Lowry Street, Smyrna)

6

Phone Number

 *

Phone Number

Phone Numberext.

Alternate Phone Numberext.

7

E-mail Address

 *

E-mail Address

8

Are you a registered voter?

 *

Are you a registered voter?

Yes

No

9

How long have you lived in Smyrna?

How long have you lived in Smyrna?

10

Employment

Employment

Current Workplace

Job Title

Length of Employment

11

Business Address

Business Address

12

Business Phone Number

Business Phone Number ext.

13

Education

Education

14

Past / Current Community Involvement

 *

Past / Current Community Involvement

15

Professional Organizations

Professional Organizations

16

Explain why you would like to serve on the Project Assistance Board.

 *

Explain why you would like to serve on the Project Assistance Board.

17

Do you know of any potential conflicts?

Do you know of any potential conflicts?

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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