Youth Council Committee Application

Applicant Information

Student Name(Required)

Age(Required)

School(Required)

Grade(Required)

Home Address(Required)

Cell Phone(Required)

Email(Required)

Parent / Guardian

Parent / Guardian Name(Required)

Parent / Guardian Address(Required)

Race or Ethnic Group

The City of York does not discriminate based on race, ethnicity, sex, creed, national origin or disability. This information need not be provided. It is requested to facilitate the City of York’s goal of assembling a diverse group. Omitting this information will not affect your application.

Race or Ethnic Group(Required)

Other (Please Specify)

Gender(Required)

Female

Male

Birth Date(Required)

Participation

Please check all that apply

I have transportation to get to Youth Council meetings/events.

I initiated my interest in this program.

I was asked to apply for this position.

By Whom?

Position

Organization

Short Answers

Why do you want to serve as a member of the Youth Council Committee?(Required)

What are the three most important issues to you, your friends and your family concerning your neighborhood?(Required)

Please list any other activities you will be involved in during the school year. Include employment, sports, community, school and religious groups.(Required)

What personal skills and characteristics do you possess that would make you a good representative?(Required)

If you could bring one thing to this city or change one thing, what would it be?(Required)

Commitment

Are you willing to attend the meetings, events and activities of the Youth Council for one year and commit to making a difference in our city?(Required)

Yes

Do you have transportation to/from meetings and events?(Required)

Yes

References

Please list two adult references (non-relatives) with phone numbers. You must also attach letters of recommendation from these individuals.

Reference #1 Name(Required)

Reference #1 Phone(Required)

Reference #1 Letter(Required)

Accepted file types: pdf, doc, docx, jpg, png, Max. file size: 50 MB.

Reference #2 Name(Required)

Reference #2 Phone(Required)

Reference #2 Letter(Required)

Accepted file types: pdf, doc, docx, jpg, png, Max. file size: 50 MB.

Applicant Signature

I have read and understand the commitment required for the Youth Council Committee. I also realize the importance of teamwork and cooperation and I am willing to make this commitment.

Signature(Required)

Date(Required)

Parental Consent

Parent/Legal Guardian Permission: I give my permission for the applicant to seek the position of committee member on the City of York Youth Council Committee.

Signature(Required)

Date(Required)

Address(Required)

Cell Phone(Required)

Email(Required)

Emergency Contact

Parent/Legal Guardian Permission: I give my permission for the applicant to seek the position of committee member on the City of York Youth Council Committee.

Name(Required)

Cell Phone(Required)

Relationship(Required)

Applicant Information

Parent / Guardian

Race or Ethnic Group

Participation

Short Answers

Commitment

References

Applicant Signature

Parental Consent

Emergency Contact

Departments

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