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2. All members of the Committee shall be full-time residents within the Portage Public Schools district and be a full-time student. Members shall be a high school student and be no more than 18 years of age at the start of his or her term. A member of the Committee may complete his or her term even if the member completes high school during the term.
4. Name*
5. Date of Birth*
7. Street Address*
8. Email*
10. Zip Code*
11. Phone Number*
12. School Attending*
13. Current Grade*
15. Name of Parent or Guardian*
16. Email of Parent or Guardian*
17. Phone Number of Parent or Guardian*
19. How did you hear about the Youth Advisory Committee?*
21. What other extracurricular activities are you involved in (sports, employment, volunteering, clubs, etc.)?*
23. Why are you interested in being part of the Youth Advisory Committee?*
25. What unique perspective will you be able to offer if selected to participate on the Youth Advisory Committee?*
27. As a member you can serve as a youth participant for the following.

    Check all in which you are interested. 

    1. Environmental Board
    2. Human Services Board

    1. Park Board

    1. Senior Citizens Advisory Board
29. Why are you interested in participating on this board(s)?
31. The Youth Advisory Committee meets once per month on Mondays during the months of September through June. Members are expected to attend monthly meetings as well as coordinate and volunteer at special events hosted by the committee for the community.*

    1. I will be able to attend meetings and assist with events.
33. Applicant Electronic Signature Agreement*

    I agree and understand that my typed name (electronic signature) is the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement. 

    1. I agree.
35. Electronic Signature
37. Parent or Guardian Electronic Signature Agreement (if Applicable)

    I agree and understand that my typed name (electronic signature) is the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement. 

    1. I agree.
39. Electronic Signature
41. Today's Date*

    MM/DD/YYYY

Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field