Salem Youth Commission Application

Salem Youth Commission Application
The purpose of the Youth Commission is to promote positive activities, opportunities, coordinating existing services through community education, advocacy, and working with officials to share ideas to improve the lives of Salem youth.

The terms of the initial members of the commission shall be for one, two or three years and so arranged that the terms of approximately one third of the members will expire each year, and their successors shall be appointed for a term of three years each. A vacancy occurring otherwise than by expiration of a term shall be filled for the unexpired term in the same manner as an original appointment.
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail
example@example.com
Emergency Contact

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.
Emergency Contact Relationship to you
How did you hear about the Youth Commission?
Why would you like to join the Youth Commission?

0/900
Please list any extracurricular activities, community service experience, sports, and clubs that you have been or currently are involved in.
How do you envision yourself contributing to the Youth Commission and/or the community at large?
What Ward do you live in? Check the map below*

Ward 1Ward 2Ward 3Ward 4Ward 5Ward 6Ward 7
Should be Empty:

The purpose of the Youth Commission is to promote positive activities, opportunities, coordinating existing services through community education, advocacy, and working with officials to share ideas to improve the lives of Salem youth.