* 1. Personal Contact information

* 2. What school do you attend (if you attend school)?

* 3. What other extracurricular (clubs, jobs, sports, family needs, etc) do you do? What do you do for fun? Please list:

* 4. Of your extracurricular activities you participate in, please list the Youth Leadership position by importance. (ex...1. taking care of younger sister; 2. band; 3. Youth Leadership position

* 5. Why do you want to be a youth leader for Jefferson County Public Health?

* 6. Are you willing to work on the Youth Leadership Council outside of scheduled meetings? (this could include occasional nights and weekends.)

* 7. How would you describe yourself as a leader and a group member?

* 8. Goals

* 9. What experience do you have that will make you a good fit for this job?

* 10. What interests you most about tobacco prevention? How do you think you can make a positive impact?

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