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2. First Name*
3. Last Name*
5. Home Address
7. City
8. State
9. Zip Code
11. School*
12. Elementary School District*
14. Grade*
15. Birth Date*
16. Age*
18. Parent/Guardian Name*
19. Phone Number*
21. Parent/Guardian Name
22. Phone Number
26. Tell Us About Yourself!
28. Please share with us what you are involved with in your school. This could be clubs, sports teams, interest groups, etc.
30. Please tell us about what you do outside of school - interests, church, hobbies, clubs, music, etc.
32. Choose three words that you think best describe you, and explain why.
34. Everyone has ideas about things that need to be improved in their community. If you could change three things in the Charlottesville community, what would they be and why? What are some ideas you have that could help change these things?
36. Why are you interested in joining the Charlottesville Youth Council?
38. Everyone is unique in some way. Tell us what unique qualities, talents, and experiences you have that would benefit the Youth Council.
42. Personal References

    Please list the names of two adults (not related to you) who know you well (teacher, coach, employer, youth pastor, etc.). We may contact these people, so please be sure to ask them first!

44. Name
45. Position
47. Email
48. Phone
50. Name
51. Position
53. Email
54. Phone
56. Commitment Pledge

    Please  note: while it is true that being a member of the Charlottesville Youth Council may "look good" on a resume or college application, we strongly discourage anyone who is joining solely for that reason. There is time and commitment involved. This is a group of youth who are committed to making a difference in our community, who want to have fun, learn about local government, have a voice and use it, and want to represent the youth of Charlottesville. 

    Please be aware of the following requirements of all members:

    • Attend monthly meetings of the Youth Council
    • Represent the interests of the student body of your school
    • Actively participate in meetings and projects - everyone's ideas are important!

    Your signature below constitutes a pledge that your responses to the questions in this application are accurate and entirely your work. In addition, you understand and will follow the requirements of the Charlottesville Youth Council if you are selected to represent your school, social group, community, and the City of Charlottesville.

58. Signature
59. Date
61. RECOMMENDATION
    Personal Recommendation Form

    This form must be submitted by the application deadline.

63. Upload your resume (optional)
65. Phone Number*
67. Email*
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69. 1. Receive an email copy of this form.
70. Email address

    This field is not part of the form submission.

71. Submit

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