Please submit this application for the Caswell Youth Council for consideration. You may find it helpful to copy and paste your answers from another document to ensure you do not lose your work. For questions or assistance please contact Nicole Gibson at ngibson@caswellcountync.gov or 336-694-4129 ext 8125, or Shannon Moretz at smoretz@compassionhealthcare.org or 336-694-9331 ext 221.

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* 1. Who are you?

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* 2. Other Identifying & Accessibility Information (Note: this information will be used to evaluate equitable selection of applicants and to ensure appropriate accessibility for all participants. The Caswell Youth Council does not discriminate on the basis of sex, gender, race, disability, or country of origin.)

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* 3. Tell us why you believe it is important for youth to serve as leaders in our community. (250 - 500 words)

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* 4. Tell us about a community issue that you care deeply about. (250 - 500 words)

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* 5. Tell us what you hope to gain from this experience. (250 - 500 words)

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* 6. References (References may be adult staff and/or leaders from school, faith-based groups, other community agencies, employers or coaches. AT LEAST ONE REFERENCE IS REQUIRED. Please ask references to submit their recommendation at https://www.surveymonkey.com/r/CYCREF )

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