Capital Region Community Foundation
Youth Advisory Council (YAC) - Member Profile and Policy Consent
Name
*
First Name
Last Name
My preferred pronouns are:
He/Him, She/Her, They/Them
YAC member Cell Number
*
ex. 517-555-5555
YAC member Email
*
example@example.com
Name of your school
*
What grade are you in?
*
Primary Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian 1 Name
*
Parent/Guardian 1 Cell Number
*
Parent /Guardian 1 Email
*
example@example.com
Parent/Guardian 2 Name
Parent/Guardian 2 Cell Number
-
Area Code
Phone Number
Parent/Guardian 2 Email
example@example.com
If you had $5,000 to make your community a better place for teens, how would you use it?
Can you commit to attending 3 meetings in Lansing during the school year, and also at least 2 activities in the Tri-County?
*
Tee shirt size (YAC shirts do run a bit small)
*
Signature
Date signed
-
Month
-
Day
Year
Date
Save
Submit
Should be Empty: