Please complete the online form below as your Application of Interest to serve on the Peoria County Board of Health.

Name:*

Home Address:*

Phone Number:*

Employer:

Business Phone Number:

Occupation:

Email Address:

List any Boards, Commissions, or Committees on which you currently serve or have served and list dates:

Describe any volunteer, employment, or related experience that you have and list dates:

Explain why you are interested in participating as a Board of Health member:

Describe any areas of expertise or how you feel you may contribute as a Board member:

Please attach resume:

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