MPB Student Council
MPB Student Council is an opportunity for Mississippi students in 8th through 1th grade to learn leadership, civic engagement, media literacy and self-presentation skills. Plus, learn the importance of public media. Please submit your application to be a part of a fulfilling year.
Student Name
*
First Name
Last Name
Age
*
City
*
Name of School
*
Grade Level
*
Student E-mail
*
example@example.com
Mobile Number
*
-
Area Code
Phone Number
Home Number
-
Area Code
Phone Number
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Mobile Number
*
-
Area Code
Phone Number
Parent/Guardian Home Number
-
Area Code
Phone Number
List any organizations or clubs you participate in
*
Things You Like To Do
*
Check All Social Media Platforms You Are On
*
Facebook
Instagram
Snapchat
Twitter
YouTube
Other
Why are you interested in being a part of the MPB Student Council?
*
Upload Headshot
*
Browse Files
pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif
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Reference Names
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Reference Names
List two names as references that we can contact regarding your MPB Student Council application, along with their preferred method of contact (Family members not applicable).
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Place of Employment
*
Job Title
*
Preferred Method of Contact
*
Phone
Email
Both / Either
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Place of Employment
*
Job Title
*
Preferred Method of Contact
*
Phone
Email
Both / Either
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of
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