County-Wide Teen Advisory Council Sign-Up Form
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
What is your preferred method of contact?
*
Call
Text
Email
Age and grade
*
What school do you attend?
*
What issues in Jackson County are you most passionate about? (Leave blank if unsure)
Have you been involved in any clubs, programs, or leadership roles? (Leave blank if unsure)
Are you interested in: (check all that apply)
*
Planning events
Peer education
Community outreach
Advocacy
Social media/content creation
Other
Where would you like to meet? (Leave blank if unsure)
What time works best to meet for you? (Check all that apply)
*
Morning
Afternoon
Evening
Weekend
Other
The County-Wide Teen Advisory Council will hold a Summer Edition, where you can plan and attend outreach events, take the lead on creating projects, and be rewarded for your participation with gift cards, field trips, food, and other incentives. If you are not able to join us this summer, you are still welcome to attend the council during the school year. Are you interested in participating in the summer edition?
*
Yes, I would like to participate in the Summer Edition
No, I will not participate in the Summer Edition, but would like to participate in the school year
If you are participating this summer, what size T-shirt do you wear? (If you are not participating in the summer, please leave blank).
The summer kickoff meeting is scheduled for Friday, June 5th at Cascades Ice Cream Co. (In the event of rain, the meeting will be moved indoors to the Jackson County health Department). Are you able to attend?
*
Yes, I can attend
No, I cannot attend, but I would still like to participate this summer
I would only like to participate during the school year
The first meeting is scheduled for Monday, May 11th at 4 PM. It will be held at the Jackson Coffee Company, 201 South Mechanic Street. If you cannot come in-person, you can participate virtually! A Zoom link will be provided closer to the date. Please select one of the options below:
I can attend in-person
I can attend virtually
I can't attend virtually or in-person
How did you hear about this? (If a friend referred you, please put their name for a chance to win a gift card)
Questions?
Submit
Should be Empty: