American Indian Future Leader Page Week - NC Governor's Page Application

American Indian Future Leaders Page Week

This form is the official application for the NC Governor's Page Program American Indian Future Leaders Page week on November 14-17. This week is open to students aged 16-18 or in their final years of High School, who identify as American Indian. Speakers and representatives during this Page week will focus discussion on how their work impacts American Indians in North Carolina. For more information about the Governor's Page Program please visit https://governor.nc.gov/governors-page-program.
Student Name*

First NameLast Name
Email*
example@example.com
What is your tribal affiliation? (Preference granted to applicants who are enrolled in state and federally recognized Indian tribes) *
Other tribal affiliation*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Date of Birth*

MonthDayYear
Date
County where you reside:*
YesNo
Please share your activities, interests, honors, etc.*
Why are you interested in serving as a page? (Type at least 3 sentences) *
100 word minimum
What if any questions would you like to be asked related to American Indian issues?
100 word minimum
We need at least one reference/recommender (non-family related) who will be able to speak to your fit for the program. Please have the recommender send an email or letter to govpage@nc.gov or erinn.foote@nc.gov .

It is the responsibility of the applicant to convey the instructions to the recommender. Any applications without a recommendation will not be accepted.
Reference

First NameLast Name
Phone Number of Reference

Area CodePhone Number
Email of Reference
example@example.com
Parent/Guardian Full Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Phone Number

Area CodePhone Number
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Should be Empty:

American Indian Future Leaders Page Week