If you're having difficulty completing it or have any questions about your application, please contact Emily Hartmann at
emily.hartmann@mass.gov
or (617) 660-8300.
Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Address
(Required)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Resume or summary of experience
(Required)
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Max. file size: 25 MB.
Statement of interest (500 words or fewer) that describes your lived experience, interests, or expertise relevant to the mission of the Board. You should also say how you would contribute to the Board’s mission as a public representative
(Required)
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Max. file size: 25 MB.
Two Letters of Recommendation which speak to your qualities, characteristics, and capabilities in terms of your ability to meet Board member responsibilities
(Required)
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Max. file size: 50 MB.
Unique ID