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Board, Commission, Committee & Special Service District Application & Certification Form

  1. Board, Commission, Committee & Special Service District Application & Certification From

    Instructions: Complete and sign this form and return it to Grand County Commission Office, 125 E. Center St., Moab, UT 84532; fax: 435-259-2574; or

  2. (residency is required for all Boards; some District boards require residency within the District, which may not include Moab City limits; two years’ residency prior to assuming board membership is required for Planning Commission)
  3. (applicable for Historical Preservation Commission and Housing Authority of Southeastern Utah)
  4. Grand County Resolution 3184 (October 2019) contains the following Board Member requirements:

    • Must be a Grand County resident (unless otherwise noted);

    • Terms shall be for four years, unless a shorter period is required by law, or unless a midterm vacancy is being filled;

    • Board Members shall have the appropriate expertise when required by law;

    • Submit applications to the Council’s Office by the requirements contained in the notice;

    • Agree to abide by the County’s Conflict of Interest Ordinance.

    Additionally, the State Code has the following requirements for Special Service Districts in Grand County:

    • No appointed member of the Board may be a full or part-time employee of the District while serving on the Board;

    • No person employed by a Special Service District as a full-time or part-time employee may serve on the Governing Board of the District;

    • A Board Member may not be compensated separately as a Board Member and as an employee for providing the same service;

    • Each Trustee/Board Member appointed by the County legislative body shall be an elector (registered voter) of the District

  5. I have read, and I certify, that all the information on this form is true and correct and I meet the requirements listed above. Furthermore, if appointed, I agree to faithfully attend the meetings and adhere to the State laws, County ordinances, and adopted Bylaws that govern the Board or Commission on which I am appointed to serve. Additionally, I have read the County’s Conflict of Interest Ordinance (No. 593, 2019) and do not have any inherent conflicts in serving on the Board or Commission to which I have applied. I agree to abide by this Ordinance.

  6. Applicant Certification*
    I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.
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  8. This field is not part of the form submission.