LeadUS Mentoring Program 2015-16

Student Board of Directors Applicant Form
OUR GOAL:

To educate and empower students to actively take responsibility for keeping their campuses safe. The Student Board of Directors program provides student leaders with a hands on role in managing the program and empowering their peers in keeping their campuses safe.
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Personal Information
Name

First NameLast Name
Email
example@example.com
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

City

Postal / Zip Code
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
1. PARENT/GUARDIAN NAME

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
2. PARENT/GUARDIAN NAME (if there is only one to list, enter N/A)

First NameLast Name
Parent/Guardian Phone Number (if there is only one to list, enter N/A)
Please enter a valid phone number.Format: (000) 000-0000.
What school are you attending and what grade are you in:
Please list your current extracurricular activities, if any:
Please describe in details some of your greatest strengths and weaknesses
Please tell us why you're interested in joining this Board
Student Board members are expected to attend scheduled meetings, school events (such as football games), fundraisers, and community events throughout the year. We understand that school, family and other activities may sometimes create conflicts. However, being a Student Board member means making a commitment to participate whenever possible and being an active representative of Crime Stoppers. Are you able to make this commitment?
After your application has been reviewed you may be asked to interview in order for us to get to know you better.

Thank you for your interest.

I certify, by my signature, that the information contained within this application is true, accurate, and complete to the best of my knowledge. An electronic signature is accepted.
Signature
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Student Board of Directors Applicant Form

OUR GOAL:

Personal Information