Youth Civics Council

Salisbury Wicomico Youth Civics Council Application

If you are interested in applying for a membership of the Youth Civics Council, please complete the following application. Applicants must be in the 8th-12th grade. All of the following information must be completed for consideration of the Youth Civics Council.

Name*
First Last
Age*
Please enter a number from 12 to 19.
School*
Grade*
Please enter a number from 7 to 12.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Home Phone*
Cell Phone*
Email*
Parent/Guardian Name*
First Last
Gender*
- Male
- Female
Check all that apply*
- I have transportation to get to Youth Civics Council meetings
- I myself am choosing to apply for this position
Why do you want to serve as a member of the Youth Civics Council*
Please list any other activities you will be involved with during the school year. Include community sports, community activities, school clubs, religious groups, employment etc.*
What skills do you possess that would make you a strong leader and representative?*
What do you want to see change in the City of Salisbury?*
Please list two adult references below with their phone numbers*
First Last
Phone*
*
First Last
Phone*
Parent/Guardian Permission*
- Confirm
I give my permission for my child to seek the position of representative on the Youth Civics Council