YHM Community Advisory Board — Member Application
Share your interest and background for an advisory role with quarterly meetings in Charleston, WV.
The Community Advisory Board is a small group of local leaders and parents who advise YHM on its work in Charleston, WV. The commitment is light by design: quarterly meetings, informal contact whenever you can, and a one-year renewable term. The role is advisory only — no vote, no legal or financial duties, and no giving or fundraising. Questions? Contact Tony Losacco, Founder & President, at (304) 533-4303 or info@yhmusa.org.
Contact Information
Full name
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First Name
Last Name
Email
*
example@example.com
Phone
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Please enter a valid phone number.
Format: (000) 000-0000.
City and ZIP code
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Preferred contact method
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Phone call
Text
Email
I confirm I am 18 or older
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I confirm I am 18 or older
Work & Background
Occupation or job title
*
Employer
Highest level of education
Please Select
High school/GED
Some college
Trade/vocational
Associate's
Bachelor's
Master's
Doctorate
Prefer not to say
LinkedIn profile URL
Parents & Guardians
Are you a parent or guardian? Check all that apply.
Parent or guardian of a middle schooler
Parent or guardian of a high schooler
Parent or guardian of a young adult
Parent or guardian of a younger child
Not a parent or guardian
Community Ties
How long have you lived in the Charleston / Kanawha County area?
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Less than 1 year
1–5 years
6–10 years
More than 10 years
I live outside the area
Churches, organizations, boards, clubs, or associations you belong to or have been active in
Have you served on a board or committee before? If yes, which ones?
What communities, neighborhoods, or groups are you connected to?
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Experience & Perspective
Areas of experience or perspective
Parent or guardian
Youth work or ministry
Education/schools
Faith community
Social services
Juvenile justice or law enforcement
Healthcare
Recreation or sports
Homelessness or housing
Business
Media or marketing
Legal
Finance
Lived experience with the issues YHM addresses
Other
Short Answers
Why do you want to serve on YHM's Community Advisory Board?
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What needs or gaps do you see for youth and families in Charleston?
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Who could you introduce YHM to — people, organizations, or groups?
How did you hear about the board? Did anyone refer you?
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Availability
Can you attend quarterly formal meetings?
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Yes
Most of them
No
Preferred meeting times
Weekday daytime
Weekday evening
Weekend
Meeting format preference
In person
Virtual
Either
Disclosures
If yes, please describe.
Advisory Board members do not need a background check to serve. If you take part in any YHM activity involving direct contact with youth, a background check is required first.
Would you be willing to complete a background check if your involvement includes contact with youth?
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Yes
No
YHM is a faith-based ministry. Faith is offered, never required — you do not need to share our faith to serve. We ask that members respect YHM's mission.
I respect YHM's mission.
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I respect YHM's mission.
Acknowledgment & Signature
Required acknowledgments
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I have read the Community Advisory Board Member role description.
I understand the role is advisory only: no vote, no legal or financial duties, and no giving or fundraising.
I agree to keep private anything I learn about the people YHM serves and any YHM matter shared in confidence.
I understand members do not speak for YHM publicly, including to the media or online, without Tony's approval.
I understand members are appointed, and may be removed, by the Founder or the Board, and that applying does not guarantee a seat.
E-signature
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Date
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-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Do you hold a role (employee, owner, board member, or contractor) with any organization that offers services similar to YHM's or does business with YHM?
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Yes
No
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