Salisbury Youth Council Application

The mission of the City of Salisbury Youth Council is to enhance, and strive for a more positive community that is youth friendly, inclusive and diverse, fair and equal, a livable community for future generations and provide quality services for all citizens.

If you are interested in applying for Salisbury Youth Council membership, please complete the application.

Applicant Qualifications:

Ø MUST be a resident of Rowan County

Ø MUST be entering grades 9, 10, 11 or 12 for the 2020-21 school year

Ø MUST maintain a GPA of 2.5 or better

All information must be completed in order to be considered for the Salisbury Youth Council.

Name *

First Name Middle Name Last Name

School *

Birth Date *

Date

Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number *

Area Code Phone Number

Email Address *

Parent/Guardian *

First Name Last Name

Parent/Guardian Email *

example@example.com

The City of Salisbury does not discriminate based on race, ethnicity, sex, creed, national origin or disability. The requested information is to help facilitate the City of Salisbury’s goal of assembling a diverse group. Omitting this information will not affect your application.

Race or Ethnic Group

African American American Indian Asian Caucasian Hispanic Middle Eastern

Gender

Female Male

Are you willing to attend meetings, events, and activities of the Youth Council and commit to making a difference in our community? *

Yes No

Are you interested in community service projects? *

Yes No

Please check all that apply: *

I have transportation to get to Youth Council meetings and activities I have initiated my interest in this program I was asked to apply for a position on the Youth Council

If asked to apply, please type the person's name, position and organization affiliation. *

Essay question: Based on the mission of the Youth Council why do you want to serve as a member? *

What three community issues are most important to you, your friends and your family? *

List any other activities you will be involved in during your school year. Include employment, sports, community, school and religious groups. *

What personal skills and characteristics do you possess that would make you a good representative? *

If you could bring one thing to the City of Salisbury or change one thing, what would it be? How would you lead a project that focused on enhancing our community? *

References:

Please list the name and phone number of two adult references who are not related to you. They can be your school principal, guidance counselor or teacher, or community leader who is familiar with you.

Reference #1 *

First Name Last Name

Reference #1: Email *

example@example.com

Reference #1: Relation *

School Supervisor (work) Community Leader

Reference #2 *

First Name Last Name

Reference #2: Email *

example@example.com

Reference #2: Relation *

School Supervisor (work) Community Leader

I understand the commitment for the City of Salisbury’s Youth Council. I also understand the importance of teamwork and cooperation and I am willing to make this commitment.

Your E-Signature *

Clear

Date *

Date

Parent or Guardian's Signature *

Clear

Date *

Date

Emergency Contact Information *

First Name Last Name

Emergency Contact Phone *

Area Code Phone Number

Emergency Contact Email *

example@example.com

Emergency Contact Relationship to Youth *

Application for Membership