Youth Advisory Council Application
Please be sure to complete the entire application. Applications are due back by September 16, 2024
Student Information
Applicant's Name
*
First Name
Last Name
Birthdate
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Parent/Guardian Information
Parent/Guardian 1 Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Parent/Guardian 2 Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Is at least one parent/guardian aware that you are applying for this council?
*
Yes
No
School Information
School Name
*
Principal's Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
School Website (if any)
Response Questions
What are the top three social issues from the list below that you consider yourself passionate about?
*
Please Select
Animals (homeless pets, endangered animals, abused animals
Community revitalization
Disaster relief
Domestic abuse
Education/tutoring/mentoring
Unemployment
Environment/conservation
Healthcare
Health-related issues (cancer, HIV/AIDS, obesity, etc.)
Homelessness
Housing (building, renovation)
Human Rights
Hunger
People with disabilities
Poverty
Recreation/sports
Senior Citizens
Technology
Female empowerment
Youth Leadership
*
Please Select
Animals (homeless pets, endangered animals, abused animals
Community revitalization
Disaster relief
Domestic abuse
Education/tutoring/mentoring
Unemployment
Environment/conservation
Healthcare
Health-related issues (cancer, HIV/AIDS, obesity, etc.)
Homelessness
Housing (building, renovation)
Human Rights
Hunger
People with disabilities
Poverty
Recreation/sports
Senior Citizens
Technology
Female empowerment
Youth Leadership
*
Please Select
Animals (homeless pets, endangered animals, abused animals
Community revitalization
Disaster relief
Domestic abuse
Education/tutoring/mentoring
Unemployment
Environment/conservation
Healthcare
Health-related issues (cancer, HIV/AIDS, obesity, etc.)
Homelessness
Housing (building, renovation)
Human Rights
Hunger
People with disabilities
Poverty
Recreation/sports
Senior Citizens
Technology
Female empowerment
Youth Leadership
Are you a member of your school's student council or student government?
*
Yes
No
Are you a member of another local youth council?
*
Yes
No
If yes, what is the name of the group(s) and what is your role?
Approximately how many hours of community service did you complete this past year?
*
Can you commit to being an active member of the council through the entire school year?
*
Yes
No
How did you hear about this program?
*
Please list any additional leadership roles/positions you have held or service awards you have received (include dates, names of awards, and your role titles)
Narrative Questions
List 3 skills or traits that an exemplary leader possesses and illustrate how you have demonstrated these skills or traits in your own volunteer work:
*
Choose one social issue that you are passionate about. What inspired your commitment to this issue?
*
Name someone who has been an inspiration to you. What about them inspires you?
*
Please attach a letter of recommendation:
*
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Applicant Signature
Please verify that you are human
*
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