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
Please list any dietary restrictions.
Parent/Guardian

First NameLast Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone Number

Area CodePhone Number
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

Other
Gender
Are you willing to attend meetings, events, and activities of the Youth Council and commit to making a difference in our community?
Are you interested in community service projects?
Please check all that apply:
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
Date

MonthDayYear
Date
Parent or Guardian's Signature
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