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2. Thank you for your interest in serving as a student representative on an advisory board or commission. This application will be kept on file for one year. The file of completed applications is open for public inspection upon request.

4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip*
13. Phone *
14. Email*
16. Parent/Legal Guardian *
18. Parent/Legal Guardian Phone *
20. School Name *
21. Grade *
22. Graduation Year *
24. Please list all academic, extra curricular activities, or work commitments. Include the time required for each activity every day of the week. *
28. I understand the responsibilities involved with participation on the City of Jackson Youth Council, Boards and Commissions (including required meeting attendance, event participation and sub-committee involvement). If an appointed member of the Youth Council accumulates three unexcused absences for mandatory events or regularly scheduled meetings throughout the year, they will no longer be able to serve on the Youth Council. I also understand that I will provide the City of Jackson a signed document from a parent or legal guardian that says I have their permission to serve on the Youth Council.
30. Digital Signature of Applicant *
32. This application can be downloaded and printed from cityofjackson.org/youthcouncil.
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34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field