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Youth Advisory Council Application
This form has been modified since it was saved. Please review all fields before submitting.
Name
*
Gender
Female
Male
Address
*
City
*
State
*
Zip
*
Home Phone
Other Phone
E-mail
Name of School
Year in School
-- Select One --
7th Grade
8th Grade
Freshman
Sophomore
Junior
Senior
If not in school, when did you last attend full time.
If not in school, when did you last attend full time.
Age
*
Race/Ethnicity
American Indian or Alaska Native
Asian
Black or African American, Non Hispanic
Hispanic
Native Hawaiian or other Pacific Islander
White, Non Hispanic
Other
If other, please specify
Are you currently employed?
*
Yes
No
Hours worked per week:
*
Parent/Guardian Name (if 18 years or under)
Relationship
Address
City
State
Zip
Home Phone
Work Phone
Cell Phone
Please describe any current or previous involvement with M-NCPPC / Xtreme Teens/ or a youth organization during out-of-school time.
Please list any current or previous extracurricular, volunteer experiences or leadership roles you have had in your school or community.
Briefly explain why you would like to participate in the Youth Advisory Council.
Write a statement describing your feelings on current opportunities for youth voice or youth involvement on important decisions in Prince George’s County.
What other problems or issues are most important to you?
If you are selected, you will be expected to reach out to your peers in the youth leadership organization that you represent. Please describe some ways you plan to engage your peers.
Are you a member of your school’s student council or student government?
*
Yes
No
Are you a member of another local youth council?
Yes
No
If ‘yes’ to the previous question, what is the name of the group(s) and what is your role?
Are you a member of a national youth council?
*
Yes
No
If ‘yes’ to the previous question, what is the name of the group(s) and what is your responsibility?
Approximately how many community service hours did you complete in the previous school year?
*
-- Select One --
Less than 5 hours
5-25 hours
26-50 hours
51-75 hours
More than 75 hours
The Youth Advisory Council is a time-consuming commitment, please provide a list of your current activities.
*
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Email address
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