Salisbury Youth Council Application

Application for Membership

"Youth for Youth"
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 current 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 NameMiddle NameLast Name
School*
What grade are you in?*
Birth Date*

MonthDayYear
Date
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Email Address*
Parent/Guardian*

First NameLast 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 AmericanAmerican IndianAsianCaucasianHispanicMiddle EasternOther
Gender

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

YesNo
Are you interested in community service projects?*

YesNo
Please check all that apply:*

I have transportation to get to Youth Council meetings and activitiesI have initiated my interest in this programI 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? *
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*

MonthDayYear
Date
Parent or Guardian's Signature *

Clear
Date*

MonthDayYear
Date
Emergency Contact Information*

First NameLast Name
Emergency Contact Phone*

Area CodePhone Number
Emergency Contact Email*
example@example.com
Emergency Contact Relationship to Youth*
Should be Empty:

Application for Membership