FY25 Youth Advisory Council (YAC) Enrollment

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* 1. Your First and Last Name

First Name

Last Name

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* 2. Your Home Address

Street

City/Town

Zip Code

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* 3. Your Phone or Cell Number

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* 4. Name of Your Parent(s)/Guardian(s)

Mother

Father

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* 5. Parent(s)/Guardians' Email Address.

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* 6. A Parent/Guardian's Phone or Cell Number

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* 7. Your Gender

Male

Female

Other (please specify)

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* 8. Name your school, please include middle, high or homeschooled.

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* 9. What grade are you in?

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* 10. Your Age