AgriSafe Young Advisors Council (AYAC) Application

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* 1. Applicant Information

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Date of Birth

MM/DD/YYYY

Date

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* 3. Parent/Guardian Information

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 4. Are you currently enrolled as a student?

Yes, full time in graduate school

Yes, part time in graduate school

Yes, full time at a four year undergraduate college/university

Yes, part time at a four year undergraduate college/university

Yes, full time at a two year undergraduate college/university

Yes, part time at a two year undergraduate college/university

Yes, at a high school or equivalent

No, I am not currently enrolled as a student

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* 5. What is the highest level of education you have completed?

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* 6. What is the best method to reach you?

Text

Phone

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* 7. I currently participate in the following clubs/activities:

Academic

Extracurricular

Community

Volunteer

(Briefly describe your role/title in the club/activity)

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* 8. Please describe why you would like to volunteer with AgriSafe Youth Advisory Council (AYAC).

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* 9. Please describe the type of agricultural work that you are currently involved in or plan to work in. (for example: agronomy,horticulture, animal sciences, livestock, crops)

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* 10. Name several key traits of an effective leader? Which one is the most important one to you? Explain why. (Be specific)

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* 11. How did you hear about AgriSafe Youth Advisory Council (AYAC)?

FFA (State or National)

4-H

Other (please specify)