Governor's Youth Council Application Survey

1.Name of High School

2.Current Grade Level

Freshman

Sophomore

Junior

Senior

3.Name of State Senator

4.Name of State Representative

5.Can you and your legal guardian commit to attending at least three of the four business meetings held per year in various locations in Pennsylvania? (Travel expenses will be reimbursed.)

Yes

6.There will be discussions and debates about issues, projects for written and verbal presentations to state agencies such as the Pennsylvania Game Commission, Pennsylvania Fish and Boat Commission, the state legislature, and the Governor. Are you willing to participate wholeheartedly in preparations, discussions, and presentations?

Yes

7.Why do you want to be a Council member?

8.Please tell us about your experience that makes you a good candidate for the Council?

9.Please tell us about any education, volunteer work, extracurricular activities or experience with any similar organizations.

10.Please provide a reference we can contact

Name

Organization

Address

Email Address

Phone Number

11.Please provide a second reference we can contact

Name

Organization

Relationship to Applicant

Email Address

Phone Number

12.Please provide a third reference we can contact

Name

Organization

Relationship to Applicant

Email Address

Phone Number

13.Please provide your contact information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

County

Email Address

Phone Number

14.Please provide contact information for a parent or legal guardian

Name

Email Address

Phone Number

15.Please provide contact information for a second parent or legal guardian

Name

Email Address

Phone Number

Governor's Youth Council Application

(High School Students, Ages 14 through 18)