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Commission Member Application

  1. This application is for Roseville residents interested in volunteering with a City of Roseville Advisory Commission.

    In order to complete this application, you will need a valid email address. All items marked with a star (*) are required fields.

  2. Under state statute, Commissioner's names, addresses and either a phone number or an electronic address where you can be reached are public information. All other personal information is private data and cannot be released to the public unless the Commissioner gives permission for the City to release it. Information relating to a student representative is private data and will not be released.

  3. Commissions*

    Please indicate the commission(s) for which your are applying:

  4. There is no character limit for the fields below.

  5. Additional information may be emailed to or delivered to Administration Department, City of Roseville, 2660 Civic Center Drive, Roseville, MN 55113 or faxed to 651-792-7020.

  6. Minnesota Government Data Practices Act*

    I understand that information provided in this application may be distributed by the City to the public including, but not limited to, being posted on the City of Roseville website. I agree to waive any and all claims under the Minnesota Government Data Practices Act, or any other applicable state and federal law, that in any way related to the dissemination to the public of information contained in this application that would be classified as private under such laws. I understand that I may contact the responsible authority for the City of Roseville if I have any questions regarding the public or private nature of the information provided.

  7. Minnesota Statute §13.601. subd. 3(b)*

    Occasionally, City staff receive requests from the media or from the public for ways to contact Commission members. The Commission roster is periodically made available. Under Minnesota Statute §13.601. subd. 3(b), either a telephone or electronic mail address (or both) where you can be reached must be made available to the public. Please indicate which contact method the City may make available for inclusion on the Commission roster.

  8. Acknowledgement*

    I have read and understand the statements on this form, and I hereby swear or affirm that the statements on this form are true.

  9. Leave This Blank:

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