Gwinnett Clean & Beautiful's Green Youth Advisory Council Application

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* 1. Contact Information

Name

Grade Level as of 09/01/2021

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Home Phone

Cell Phone

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* 2. Parent/Guardian Contact Information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Cell Phone Number

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* 3. School Contact Information

Principal's Name

Principal's Email Address

Teacher Liaison's Name

Teacher Liaison's Email Address

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* 4. Please list other extra-curricular activities (service clubs, athletics, band, etc.) that may interfere with monthly meetings and weekend activities, events, etc. and your commitment to the Gwinnett Clean & Beautiful Green Youth Advisory Council.

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* 5. Briefly describe your school including whether it is public, private, charter or home.

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* 6. How did you hear about the Green Youth Advisory Council?

Teacher

School Staff

Friend

GC&B Website

Other (please specify)

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* 7. Choose one issue that you are passionate about which is related to the GC&B mission of “Connecting People and Resources for a Sustainable Gwinnett”, and focus areas. What is your commitment to this issue?

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* 8. Are you a member of your school’s environmental club?

School does not have a club

Yes (please list your teacher sponsor's name below.)

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* 9. If you answered yes to the previous question, what is the name of the club / group and describe your role.

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* 10. What experience do you hope to gain by being a member of the Green Youth Advisory Council?

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* 11. How do you plan to make an impact, either on your own or with other service groups at your school or in your community?

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* 12. What is the most important quality you will bring to the Green Youth Advisory Council?

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* 13. If accepted to Gwinnett Clean & Beautiful's Green Youth Advisory Council, I understand the requirements as outlined below and commit to the following:

1.     Be actively engaged and attend all meetings and events

2.     Commit to a project and actively help my team work to achieve results

3.     Read and respond to all correspondence including but not limited to emails and text messages about Green Youth Advisory Council happenings within 48 hours of receipt

Student Signature and Date

Parent Signature and Date