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)


    Emergency telephone number (required)