Language
English (US)
Spanish (Latin America)
YAC APPLICATION
Name
*
First Name
Middle Name
Last Name
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Date of Birth
*
/
Month
/
Day
Year
Date
Grade for 2022-2023 School Year
*
Name of High School
*
ISD
*
List any youth councils / clubs / activities you are a part of, including leadership positions:
*
What do you know about Teen Violence? Domestic Violence (DV)?
*
Does your high school offer education on DV?
*
Yes
No
Do you believe DV is a problem in your district / high school? If so, why?
*
On a scale of 1 to 10 how proactive has your district / high school been in combating DV (1 not at all, 10 very proactive)?
*
Not at all
1
2
3
4
5
6
7
8
9
Very proactive
10
1 is Not at all, 10 is Very proactive
If selected, what topics would you be interested in discussing?
*
Are you willing to commit to a minimum of 1 meeting per month, and additional engagement with your committee?
*
Yes
No
Do you have any additional thoughts and/or experiences with domestic violence that you would like to share? (optional)
Are you the Applicant or Parent/Gaurdian of the Applicant?
*
Applicant
Parent/Guardian
I certify that the knowledge on this application and any additional material submitted are true and complete to the best of my knowledge. I commit to attending all meetings unless extenuating circumstances arise.
*
I certify and acknowledge
I herby give my consent for my child to participate in the FVPS Youth Advisory Council and understand that he/she is expected to be present at all meetings.
*
I give my consent
Submit
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