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Lane Youth Transportation Advisory Council
Participant Application Form
Name:
First Name
Last Name
Pronouns
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Phone Number
*
If you are in school, which school do you attend?
What grade are you in?
7th
8th
9th
10th
11th
12th
College
Other
If you are not in school, what are you plans for this year?
How did you hear about the Lane Youth Transportation Advisory Council?
Why do you want to be a member of this committee? Please describe any communities you represent or could help engage in the work.
Tell us about some of the transportation issues that are most important to you in your neighborhood, your city, and the broader community of Lane County.
Council members will commit to 7 hours per month on council work, this includes the required monthly meeting. Describe other school or community activities you are involved in and how will you balance your schedule in order to honor the commitment to participate in the committee.
Tell us about any experience you have in community service or advocating for community improvement (it does not have to be transportation related).
What else would you like us to know about you? Feel free share any hobbies you have, something you are proud of or any other interest you have.
Tell us how you travel. Rank from More Frequent (1) to Less Frequent (7)
1
2
3
4
5
6
7
Walking
Biking
Bus
Skateboard
Scooter/Rollerskating/Hoverboard
You drive yourself
A parent or friend drives you
I understand that this council is a commitment that requires a monthly 2 hour meeting and additional 3-5 hours/month of volunteer time throughout the school year. I commit to fulfilling this responsibility.
YES
NO
Name
First Name
Last Name
Signature
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