Teen Advisory Group Application

Your Name (required)

Your Email (required)

Your age

Your grade (required)

How many months are you willing to commit? (The board meets once/month.)
 3 months 4 months 5 months 6 months More than 6 months

Days you would be available (check all that apply)
 Monday 3pm-6pm Tuesday 3pm-6pm Wednesday 3pm-6pm Thursday 3pm-6pm Thursday 6pm-9pm Friday 3pm-5pm

Why do you want to join the Teen Advisory Board?

Anything else you'd like us to know?

Person to contact in case of emergency (required)


Emergency telephone number (required)