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 months4 months5 months6 monthsMore than 6 months

Days you would be available (check all that apply)
Monday 3pm-6pmTuesday 3pm-6pmWednesday 3pm-6pmThursday 3pm-6pmThursday 6pm-9pmFriday 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)

Relationship

Emergency telephone number (required)