Youth Advisory Board Application

Are you between 13 and 18 years old?

Do you have a genuine desire to help other people, including seniors and adults with disabilities?

Can you meet our minimum monthly time commitment of between 2 and 4 hours?

Do you see yourself as a leader?

Do you want to build professional skill-sets that will help with future employment?

If so, please fill in this form if you would like to be considered for a VOLUNTEER position with our Youth Advisory Board. All information will be kept confidential.

Name

First NameLast Name

Cell phone

Please enter a valid phone number.Format: (000) 000-0000.

Home phone

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth

Date

Gender identity and pronouns used

What languages do you speak?

Which cultural background/s do you identify with?

Parent/Guardian:

First NameLast Name

Parent/Guardian Cell Phone:

Please enter a valid phone number.Format: (000) 000-0000.

Parent/Guardian Home Phone:

Please enter a valid phone number.Format: (000) 000-0000.

Parent/Guardian Email Address

example@example.com

Please tell us a bit about yourself! (GPA, activities, hobbies, sports participation, living situation)

Can you tell us why you are interested in joining the Circle of Care, St. Louis Youth Advisory Board?

What skills and ideas could you bring to the Youth Advisory Board?

Are you currently or have you been involved with any other organizations or groups?

Is there any other relevant information you would like to share??

Photo/Video Release:

Circle of Care, St. Louis may, at its discretion, photograph or video activities participated in by Youth Advisory Council members. By checking the box below, you agree (if under 18 a parent or guardian must have read and agree) to the following:

I grant Circle of Care, St. Louis, its representatives and employees the right to take photographs of me and my property in connection with my participation in their Youth Advisory Board. I authorize Circle of Care, St. Louis, its assigns and transferees to copyright, use, and publish the same in print and/or electronically.

I agree that Circle of Care, St. Louis may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

Thank you for your time. When you are happy with your answers please hit the 'submit' button below. Someone will be in touch with you to discuss your application shortly.

Youth Advisory Board Application

Personal Details

About You