JAG Youth Council - Member Application 2011-2012

Application for

JAG YOUTH COUNCIL

A Program of Juvenile Advocacy Group (JAG) & Department of Public Health

Type or print legibly. Please visit www.JagNetwork.org for an electronic version and up-to-date info.

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Cell Phone

Area CodePhone Number

Home Phone

Area CodePhone Number

E-mail

Age

School

Grade

OPTIONAL DEMOGRAPHIC INFO*

We seek to assemble a diverse group of youth to serve on the JAG Youth Council. Therefore, completing the demographic information below is encouraged, but not required.

*Race/ethnicity

1. List Volunteer Experience, Hobbies, and Interests.

2. Why do you want to become a member of the JAG Youth Council

3. What is a community issue you hope can be addressed by the JAG Youth Council? Why?

4. What assets will you bring to the JAG Youth Council? (i.e., optimistic, good public speaker, hard worker, punctual, etc.)

5. What are your other commitments and/or potential conflicts? (The council members are expected to meet every Wednesday from 3pm-4pm, in addition to participating with other projects throughout the year).

PLEDGE OF DEDICATION AND SERVICE

The JAG Youth Council is a program designed to place young people in a leadership role in addressing community needs. Council members will participate in a variety of service activities including community service, service-learning, distribution of grants to other youth-led service projects, and teaching other youth through service-based learning initiatives. While the JAG Youth Council is a voluntary organization, members are expected to regularly attend meetings and events. Regular attendance is a crucial component to the JAG Youth Council’s ability to fulfill its mission to serve to the community and build young civic leaders. Because of its importance consistent attendance is a requirement of the JAG Youth Council.

If accepted, I solemnly subscribe to the purpose and expectations of the JAG Youth Council,

and pledge my active participation, including but not limited to consistent attendance at JAG Council meetings and events, and support of the program goals.

I Agree to the JAG Youth Council Pledge of Dedication and Service

Meetings will begin Wednesday September 14th at 3pm at the Milford Youth Center.

Please contact Alyssa Wyman at 508-478-6888 ext 142 or email her at alyssa_wyman@waysideyouth.org with questions.

JAG YOUTH COUNCIL

A Program of the Juvenile Advocacy Group and Department of Public Health

>> Parent/Guardian Permission Form <<

The JAG Youth Council will provide Milford youth the opportunity to make grants to other youth-initiated community service-learning projects. Youth council members will receive training on how to manage a grant process and ongoing support from adult advisors, but they will have the decision making authority for determining which projects receive funding and the responsibility to manage implementation of selected grant projects. Additionally, Youth Council members are expected to participate in community service projects and identify ways that they can play a leadership role in the community. Council members will also receive training based on SCI’s Civic Skills Checklist, a tool designed to monitor the development of the practical skills needed for successful civic engagement and service initiative.

Parent/Guardian Name

First NameLast Name

Parent/Guardian Name

First NameLast Name

Home Phone

Area CodePhone Number

Work Phone

Area CodePhone Number

Cell Phone

Area CodePhone Number

Alternate Emergency Contact if parent(s) cannot be reached

Full Name

First NameLast Name

Phone Number

Area CodePhone Number

JAG email list: Enter your parent/guardian email below if you wish to be notified of other JAG programs, volunteer opportunities and community events (visit www.JagNetwork.org for more info on JAG’s programs and activities). Your email and other contact info will not be shared:

E-mail

Please note below if there is any medical information the Youth Council adult advisors should be aware of (e.g. allergies, seizures, etc.):

Parents: Please print and fill out the following form, and scan it, and attach it below. If you do not have a scanner, the parent permission slip can be given to your child at the first meeting for you to fill out. Thank you. Click here to access the parent/guardian permission slip.

Upload the Parent/Guardian Permission Slip Here please.

Upload a File

CONTACT INFO

PERSONAL QUESTIONS

PARENT CONTACT INFORMATION

OTHER INFORMATION