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Application for Advisory Board/Committee/Commission

Advisory Board Information

Please ensure there is an opening for the advisory board you're applying for and that you meet its requirements.

Applicant Information

Full Name

Home Address

Is your mailing address the same as your home address?

Mailing Address

Work Phone

Business Address

Are you registered to vote in Manatee County? (This is required for some boards/commissions)

Which County Commission District do you reside in?

Find your Commission District on your Voter Registration Card or by using our Resident Information Tool.

Do you reside in unincorporated Manatee County?

The Board of County Commissioners strives to ensure equal access for minorities and women to serve on advisory boards/committees/commissions. Providing the information below will help Manatee County compile information needed to comply with the reporting requirement in Florida State Statute 760.80.

Gender

Race

Additional Information

An application to the Citizens Oversight Committee for the Infrastructure Sales Tax requires a current and comprehensive resume or curriculum vitae. Upload your resume/CV

Supplemental Questions for Applicants to the Manatee County Children’s Services Advisory BoardPlease complete all questions with current and accurate information.

Are you or any of your immediate family members affiliated with any agency (see below) that receives Children’s Services dedicated millage funds from Manatee County? Affiliated means: an employee of the agency; owner of the agency; voting member on the agency’s Board of Directors; or contract with the agency

Please select the agency from the list below. Check all that apply:

An application to the Children's Services Advisory Board requires a current and comprehensive resume or curriculum vitae. Upload your resume/CV

An application to the Health Council of West Central Florida requires a current and comprehensive resume or curriculum vitae. Upload your resume/CV

Supplemental Questions for Applicants to the Manatee County Healthcare Advisory BoardPlease complete all questions with current and accurate information.

What is your field of expertise? (Please indicate all that apply)

Are you an employee, contractor for, owner or voting member on the Board of Directors of any agency that receives funding from Manatee County directly or indirectly?

Do you currently, or have you in the past 5 years, participated in any community health care initiatives or committees (e.g.: Health Care Alliance, Chamber Health Care Committee, Acute Care Committee, etc.)?

An application to the Healthcare Advisory Board requires a current and comprehensive resume or curriculum vitae. Upload your resume/CV

NOTE: Please do not include any information on this document that you wish to not be shared with the public as this document and all of its contents will become public record upon submission.

Additional Questions

Do you or your immediate family members have or hold any employment or contractual relationship with any business entity or agency which does business with or receives funding from Manatee County Government?

Do you know of any other reason that would prohibit you from serving on this board that could be deemed as a conflict of interest?

If you are appointed, are there any days of the week or months of the year you will be unavailable to serve due to job or travel?

The Children’s Services Advisory Board has monthly meetings which are generally on the 3rd Wednesday of each month from 3:00 pm to 5:00 pm or later. If you are appointed, will you be available at these dates and times?

The Children’s Services Advisory Board has an annual retreat which is generally held on the 1st or 2nd Friday of October from 9:00 am to 3:00 pm or later. If you are appointed, will you be available on these dates and times?

The Children’s Services Advisory Board is responsible for reviewing and scoring funding applications submitted by non-profit agencies. This generally occurs during the months of March, April and May each year, and meetings are held each Wednesday from 3:00 pm to 5:00 pm or later. The time commitment for reviewing and scoring funding applications takes members an average of 20-30 hours per week. If you are appointed, will you be available to attend the weekly meetings and commit to 20-30 hours per week to review and score funding applications?

Important Information

  1. For questions regarding a specific advisory board, committee, or commission, including the duties and requirements, please contact the County staff liaison listed on that board’s webpage.
  2. Certain advisory boards, committees, and commissions have specific membership requirements including a valid voter registration card, financial disclosure and/or the submission of other information.
  3. Attendance is required at advisory board meetings. Three unexcused absences may be grounds for removal.
  4. Florida State Statute 119.07 designates this application as a public document to be made available for anyone requesting to view it. If you qualify for exemption from public disclosure under the terms of this statute, please explain below.
  5. Advisory boards, committees or commissions having the authority to make factual determinations, review permit applications, issue permits, grant variances, or impose fines exercise a part of the County’s sovereign powers and members are prohibited by Florida law from holding more than one such position. If you currently hold another state, municipal or county government appointment, County

NOTICEApplications must be complete and signed to be valid. Resumes may not be substituted for the sections on the application but you may include extra pages to provide additional information. Applications will not be processed unless each section has been completed and all supplemental information sought by County staff has been provided.

Applicants will not be permitted to change information on their submitted application materials once they have been received by the County.

Please sign and date below
I have reviewed the qualifications of this position and the duties of the board or commission for which I am applying and certify that I am fully able to serve. I agree to commit the necessary time to fulfill these responsibilities. I understand that I am offering my service without compensation. I agree to abide by all Manatee County Commission rules and policies either published or in effect by usage, and all regulations and laws of the State of Florida. I further hereby acknowledge that should my professional, residential or other status change subsequent to my appointment to this board or commission, I have a continuing obligation to inform the County’s staff liaison of that change to the extent it may alter my eligibility to continue in service.

By typing my name and submitting this application, I confirm that the information provided in this application is true and complete, and this constitutes my signature under the Florida Electronic Signature Act.

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The Board of County Commissioners of Manatee County, Florida does not discriminate upon the basis of any individual’s disability status. This non-discrimination policy involves every aspect of the Board’s functions including one’s access to, participation, employment, or treatment in its programs or activities. Anyone requiring reasonable accommodation for meetings as provided for in the Americans with Disabilities Act should contact Carmine DeMilio at (941) 792-8784 Ext. 8203 or carmine.demilio@mymanatee.org three days before a meeting.