Student Rep Application

Student Representative Application for Appointment

Interested applicants are required to be residents of the City of Oak Ridge. All members are appointed and confirmed by City Council to serve a one-year term of office commencing on August 1. The High School representative must be a high school-age student and a resident of Oak Ridge.
Which board would you like to be student representative for?

Environmental Quality Advisory Board
Name

First NameLast Name
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
example@example.com
Home Phone
Cell Phone
Date of Birth

MonthDayYear
Date
Race (optional)
Gender (optional)

FemaleMaleOther
Do you currently serve on the YAB?

YesNo
If yes, how many years of service?
Have you previously applied for this board?

YesNo
If yes, how many times?
SCHOOL INFORMATION
School name
GPA
Grade (as of term start date, August 1)
Grade (as of term start date, August 1)
Favorite class
Extra curricular activities
VOLUNTEER/WORK EXPERIENCE
Organization/Business
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Describe this experience
Organization/Business
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Describe this experience
All information provided is considered public pursuant to the Tennessee Public Records Act.

Applicant Statement: I understand that I am applying for appointment to a Board, Commission or Committee of the City of Oak Ridge; that I will be required to provide proof of my Oak Ridge residency; that I will be required to take an oath of office to uphold the United States and Tennessee Constitutions and the laws of the same if appointed. I agree to comply at all times with all requirements of the office for which I am applying and to which I may be appointed. All statements and information provided in the applications are true to the best of my knowledge.
By checking the box to the right, you are agreeing to the terms listed above in "Applicant Statement" and are validating that you are the applicant as indicated on the form.

True
Should be Empty:

Student Representative Application for Appointment

SCHOOL INFORMATION

VOLUNTEER/WORK EXPERIENCE

All information provided is considered public pursuant to the Tennessee Public Records Act.