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Committee, Board, and Commission Interest Form

  1. Pittsylvania-County-Logo-name-only
  2. Board of Supervisors
    P.O. Box 426 • 1 Center Street Chatham, Virginia 24531 Phone (434) 432-1987
  3. *Disclaimer*
    Members of the Board of Zoning Appeals are appointed by a local judge. The Board of Supervisors can make recommendations, but a judge actually makes the appointment.
  4. Code of Ethics/Model of Excellence*

    I agree that if appointed to any Committee, Board, or Commission I will complete the required Conflict of Interest Annual Filings and will adhere to the Code of Ethics/Model of Excellence as included in the Pittsylvania County Board of Supervisors bylaws.

  5. Although it is not required, feel free to submit a resume or cover letter.
  6. DISCLAIMER: The Pittsylvania County Board of Supervisors reserves the absolute legal right to appoint an individual to any Committee, Board, or Commission. Moreover, completion and submission of the Citizen Committee Interest Form does not guarantee an appointment to a committee by the Pittsylvania County Board of Supervisors.

  7. Leave This Blank:

  8. This field is not part of the form submission.