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TPD | Youth Citizens Advisory Council Application
Student's Information
First Name
*
Middle Initial
Last Name
*
Street Address
*
Apartment/Unit #
City
*
State
*
Zip Code
*
Phone
*
Email Address
*
Name of the school you're currently attending
*
School Address
*
List of clubs/organizations including school and outside of school
*
Will you be able to attend meetings outside of school hours?
*
Why do you want to serve on the committee
*
Parent/Guardian's Information
Parent/Guardian First Name
*
Parent/Guardian Middle Initial
Parent/Guardian Last Name
*
Parent/Guardian Street Address
*
Apartment/Unit #
Parent/Guardian City
*
Parent/Guardian State
*
Parent/Guardian Zip
*
Parent/Guardian Phone Number
*
Parent/Guardian Email Address
*
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