KARUK YOUTH LEADERSHIP

KARUK YOUTH LEADERSHIP
APPLICATION
All applications MUST be completed and submitted to attend any Karuk Youth Leadership meetings or events.
Name
Age
School
Grade
Home Address
City
State
Zip
Class Dojo

After your application is submitted, you will receive an invite to our Class Dojo. This can be accessed through the Class Dojo app or via web browser. We utilize Class Dojo as our main source of information and reminders. Class Dojo is an important asset to Karuk Youth Leadership. If you do not have a phone or computer, please contact Brionna Gonzales at 530-643-2268 so we can get your invite sent to a parent or guardian.
Telephone
Email
example@example.com
Parent/Legal Guardian
Do you self-identify as Native American?

YesNo
If yes, which Tribe
Why do you want to serve as a member of the Karuk Youth Leadership?
Please list any activities you will be involved in during the school year. Include sports, employment, community, school, family obligations, etc.
What personal skills and characteristics do you possess that would make you a good representative for the Karuk Youth Leadership?
If you could bring one thing to the Karuk Tribe or change one thing, what would it be?
Are you committed to attending meetings, events and fundraisers as an active Karuk Youth Leadership member? (This includes zoom, travel).

YesNo
KARUK YOUTH LEADERSHIP COMMITMENT

I will be an active participant in Karuk Youth Leadership and do my best to attend all meetings via zoom, within my school or out of town. I understand that I MUST request transporation for out of town meetings via the education website at karukeducation.com.

I understand that I need to be connected to the Class Dojo via myself or a parent/guardian. I understand that all my participation will be tracked on my profile within Class Dojo and points will be used to determine my eligibilty to attend any conferences or conventions.

I have read and understand the commitment required for the Karuk Youth Leadership and I am willing to make this committment.
Student Signature

Clear
Printed Name
Date

MonthDayYear
Date
Parent Disclosure

When signing below, you are giving permission for your child to be an active participant as a Karuk Youth Leadership Member as well as attending inter or outer region meetings and events.
Signature of Parent/Guardian

Clear
Printed Name
Date

MonthDayYear
Date
Emergency Contact (Other than yourself.)
Relationship to Youth
Phone Number
Should be Empty:

KARUK YOUTH LEADERSHIP

APPLICATION

Class Dojo

Parent Disclosure