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* 1. First Name

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* 2. Last Name

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* 3. Your School or YMCA

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* 4. Your Current Grade

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* 5. How many years previously have you participated in the Youth and Government Program, not including this year?

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* 6. Your Cell Phone Number, or main contact phone number.  Please include only the numbers, no hyphens or parentheses. For example please enter 5551234567 not (555) 123-4567

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* 7. Your Email.  Please make sure it is spelled correctly, as this will be the way you receive communication about the program.  Please do not use a school based email address, as most have strong filters and often filter out our emails.

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* 8. If you already know what you want to work on a bill about, please explain your ideas, or ideas, if you have multiple.  This will be published for others to view and possibly indicate interest in working with you.  Your contact information will not be shared with anyone.

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* 9. Please Indicate your level of Interest in the following topic areas.  This information will be used to help find you potential Bill partners and may be made public.

  1 - Least Interest 2 3 4 5 - Most Interest I do not wish to work on this topic
Agriculture
Children and Family Services
Consumer Protection
Correctional Services
Economic Development
Education
Environmental Protection
Health and Human Services
Housing and Urban Development
Labor
Public Safety
Taxation and Finance
Transportation
Equity/Inclusion

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