Glendale AZ - Mayor's Youth Advisory Commission 2022-23 Membership Application Form

Application For 2022-2023 Membership - Mayor's Youth Advisory Commission

Application deadline: Friday, August 12, 2022 at 11:59 p.m.
Student's Name *

First Name Last Name
E-mail *
example@example.com
Phone #: *
Your address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent/Guardian Name *

First Name Last Name
Parent/ Guardian E-mail *
example@example.com
Parent/Guardian Daytime Phone #: *
Student's Birth Date: *

Month Day Year
Grade for 2022-2023 school year? *
Name of School *
Applicant must be a Glendale resident, attend a Glendale school or be homeschooled in Glendale.
How did you hear about us? *

Friend or Classmate Teacher/School Official School Announcement Recruitment Letter Mayor's Newsletter City of Glendale Webpage News Article Social Media Other
Have you previously served on MYAC? *

Yes No
Is yes, when?

2021-2022 2020-2021 2019-2020 2018-2019
Glendale City Council District *
Find your District: www.GlendaleAZ.com/your_government/city_council/district_boundaries
List the names of any siblings who have participated in MYAC:
Unisex T-Shirt Size *

Small Medium Large X Large 2X Large
Membership Questionnaire:
List any clubs, organizations or groups of which you are currently a member; *
Include extracurricular activities and any offices or positions of leadership you now hold or have held; list any awards received or significant accomplishments.
Why are you interested in being a member of MYAC? (250-300 words) *

0/300
Recommendation Form:

One (1) adult recommendation is required per application. This can be a teacher, mentor, boss, coach, pastor, or any other person who can vouch for the student's character, potential, and abilities. Click and/or share the link to the form below:
Recommendation Form

(Minimum of 1)
Expectations and Requirements:

(Please read and acknowledge)
If I become a member of MYAC, I understand that to remain in good standing with MYAC I will complete a MINIMUM of 20 community service hours by April 30, 2023 at 11:59 PM. *

I understand
If I become a member of MYAC, I understand that I am responsible for submitting my service hours and service photos for credit in a timely manner and no later than April 30, 2023 at 11:59 PM. *

I understand
If I become a member of MYAC, I understand that I can not have more than one (1) unexcused or two (2) excused absences from monthly meetings from August to April. *

I understand
Additional Bylaws will be provided upon acceptance into MYAC. *

I have read, understand, and accept the expectations and requirements listed above for MYAC membership.
Digital Signature of my Parent/Guardian agreeing to application expectations and requirements listed (above): *
Parent/Guardian must type/enter their own name
Should be Empty:

Application For 2022-2023 Membership - Mayor's Youth Advisory Commission

Membership Questionnaire:

Recommendation Form:

Expectations and Requirements: