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Mayor's Youth Advisory Council Application

Mayor’s Youth Council Application

The vision for the Mayor’s Youth Council is to empower youth dedicated to personal development and servant leadership. If you are interested in applying for membership in the council, please complete the following application. Applicants must be City residents and be in grades 9 through 12.
The applicant must complete the application in its entirety to be considered for the Mayor’s Youth Council.

Date of application 


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Name of referral source:


First Name: ​ Middle:  Last Name: 

Address of Applicant: 


Telephone Number: ​ Age 

Email Address: 

Parent/Guardian NameParent/Guardian Phone Number 

Parent/Guardian Email Address 



1. Please list any activities you will be involved in during the school year. Please include employment, sports, community, school, and other clubs or extracurricular activities.

2. What personal skills and characteristics do you possess to make you a good representative?

3. What would it be if you could bring one thing to this City or change one thing?



Please list two adult references (non-relatives) with phone numbers. 

Referral NameReferral Telephone NumberReferral Email Address



I have read and understand the commitment required for the Mayor’s Youth Advisory Council. I also acknowledge the importance of teamwork and cooperation, and I am willing to make this commitment.

Signature of Student:  Student Signature Date: 

Signature of Parent/Guardian giving permission for the student to be part of the Mayor's Youth Advisory Council if selected. 

Emergency Contact Name:  

Emergency Contact Phone Number:  

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