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1. Name (Required.)

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3. Phone

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4. Address

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5. Date of Birth (Required.)

Date

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6. Student Information (Required.)

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7. Parent's name (Required.)

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9. Parent's phone

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10. Parent's address

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11. Emergency Contact (Required.)

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12. T-Shirt Size (Required.)

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13. Why do you want to participate in the Youth Civic Advisory Board? (Required.)

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14. What does leadership mean to you? (Required.)

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15. What issue would you like to solve in your community? (Required.)

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16. Do you give consent to have your image in promotional materials (Required.)

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17. Do you agree to attend all sessions? (Required.)

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18. Parent Guardian E-Signature (Required.)

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19. Please indicate which College Park Leadership Programs you have completed previously. (Required.)

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