Youth Advisory Council Application Name:* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last How old are you?*Please enter a number from 13 to 21.Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Address:* Phone Number:*I prefer to be contacted by...* Email Phone What school do you attend and what grade are you in?* Emergency Contact Name:* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Emergency Contact Phone Number:*How did you learn about Second Story?*--SELECT ONE--Friend, community member, or word of mouthDrove by and saw your signI received services from the organizationOnline or social mediaNewspaper, radio, or print materialsOther/I don't rememberWhy do you want to be a Youth Council member at Second Story?*Please describe any past volunteer experiences.*Are you willing to commit to at least one full school year of service?* Yes No Have you ever been convicted of a crime?* Yes No If yes, please explain.*Let's keep in touch! Yes, please keep me updated on Second Story news. PhoneThis field is for validation purposes and should be left unchanged.
