Capital Region Community Foundation
Youth Action Committee - Member Profile and Policy Consent
YAC member Cell Number
YAC member Email
Name of your school
Primary Home Address
Street Address Line 2
State / Province
Postal / Zip Code
Parent/Guardian 1 Name
Parent/Guardian 1 Cell Number
Parent /Guardian 1 Email
Parent/Guardian 2 Name
Parent/Guardian 2 Cell Number
Parent/Guardian 2 Email
If you had $5,000 to make your community a better place for teens, how would you use it?
Are you available to attend at least 5 meetings and 1 service projects during the school year? (meetings may be virtual or in-person)
Please list all clubs and organizations you or your immediate family members are employed by, or a board member of.
I have read the Confidentiality Policy and Conflict of Interest Policy and agree to comply with all terms.
I have read the Youth Code of Conduct and agree to comply with its terms.
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