TPD | Youth Citizens Advisory Council Application

Student's Information

First Name*

Middle Initial

Last Name*

Street Address*

Apartment/Unit #

City*

State*

Zip Code*

Phone*

Email Address *

Name of the school you're currently attending*

School Address*

List of clubs/organizations including school and outside of school *

Will you be able to attend meetings outside of school hours?*

Why do you want to serve on the committee *

Parent/Guardian First Name*

Parent/Guardian Middle Initial

Parent/Guardian Last Name*

Parent/Guardian Street Address *

Apartment/Unit #

Parent/Guardian City*

Parent/Guardian State*

Parent/Guardian Zip*

Parent/Guardian Phone Number *

Parent/Guardian Email Address *