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2. Date

4. Thank you for your interest in serving the Town of Cohasset.  We encourage you to reach out to a Select Board Member or the Town Manager/Select Board office for information on any of the Town boards, committees, and commissions or connect directly with the chairs of committees you have interest in.

6. Please note: All appointed members will be expected to attend Committee and Open Meeting Law Trainings, be sworn in, and must take the State Ethics online test.

   Select Board

   41 Highland Avenue

   Cohasset, MA 02025

   Email – tconnors@cohassetma.org

8. Name
9. Email Address
11. Address
13. City
14. State
15. Zip Code
17. Phone Number
18. Occupation
20. Please indicate below, the Board, Commission or Committee that is of interest to you.
22. General Government

    1. Affordable Housing Steering Committee
    2. Affordable Housing Trust
    3. Cable Advisory Committee
    4. Cohasset Cultural Council
    5. Cohasset Common Historic District Commission
    6. Community Preservation Committee
    7. Conservation Commission
    8. Council on Elder Affairs
    9. Harbor Committee
    10. Historical Commission
    11. OPEB Committee
    12. Open Space Committee
    13. Recycling Committee
    14. School Facilities Committee
    15. Stormwater Advisory Committee
    16. Town Hall Building Committee
    17. Zoning Board of Appeals
    18. Roads and Sidewalks Committee
23. Troika Appointments

    1. Advisory Committee
    2. Alternative Energy Committee
    3. Bylaw Committee
    4. Capital Budget Committee
    5. Design Review Board
    6. General Interest (willing to serve as needed)

    (Consists of Moderator, Chair of Board of Selectmen and Chair of Advisory)
25. Are you a Registered Voter in Cohasset?

    1. Yes
    2. No
27. Is this application for a re-appointment to a Board, Commission or Committee you are presently sitting on?*

    1. Yes
    2. No
29. If yes, have you completed your ethics training?*

    1. Yes
    2. No
31. Is your ethics training up to date? *
    Please contact the Town Clerk's Office at 781.383.4100 x 5106 and ask for the date your ethics is valid until. Please write that date in the space provided above.
33. Have you previously been a member of a Board, Committee or Commission (either in Cohasset or elsewhere)? If so, please list the Board name and your approximate dates of service:
35. Current occupation and employer
36. Please Attach Resume
38. Do you or your employer have a current or potential business relationship with the Town of Cohasset that could create a conflict of interest?
40. Education and special training
42. Please list below any additional information or comments that may help in the matching of your interests with the most appropriate Board/Committee, such as civic experience, special interest/hobbies, etc.
44. Thank you for your interest. If you have any questions or would like more information, please contact the Town Manager’s office at 781-383-4100, ext. 5101.
48. The content below is for use by the Town Manager’s office and the appointing authority to record the status of your application.
50. Town Manager’s Office:
52. Applicant called
53. Schedule date for interview
55. Time for interview
59. Notification of Appointment:
61. Appointment letter sent
62. Committee notified
64. Applicant notified
65. No openings at this time
69. Appointing Authority: Selectmen/Town Manager/Troika
71. Interview date
72. Appointed date
74. Term
75. Board, Committee or Commission
Leave This Blank:


77. 1. Receive an email copy of this form.
78. Email address

    This field is not part of the form submission.

79. Submit

* indicates a required field