Carrollton Youth Council Student Application

In order to be considered, student applicants must meet the following criteria:
● Submittal of this application filled out in its entirety no later than the August 29th
● Have two personal reference forms submitted no later than the August 29th
● Be presently enrolled at Carrollton High School and reside within the city limits
● Have and maintain an 85 GPA or higher
● Must not have a Level II or higher discipline referral
● Must have 95% or higher school attendance
● Be able to think critically and articulate thoughts and ideas
● Have an interest in learning about government and how it functions
● Possess potential leadership skills
● Secure parental or guardian permission and support

Applicant's Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Email

example@example.com

Date of Birth

Date

Age

Current GPA

Parent(s) / Guardian(s) Names

The adults listed below as references should be able to answer questions concerning the applicant’s qualifications for a membership position on the Carrollton Youth Council. One adult reference must be from a teacher, counselor, or school administrator. The second adult reference must be from a civic or community leader. Please list them below and complete the attached reference forms also. Reference form will be send directly to them.

1. Name

Relation to Applicant

Phone

Email

2. Name

Relation to Applicant

Phone

Email

Why do you wish to become a member of the Carrollton Youth Council?

What programs, activities, or issues would you like to see addressed by the CYC?

What strengths could you contribute to the CYC?

Please list any extracurricular activities in which you have been or will be involved.

Please list any involvement in community service or special projects.

The CYC generally meets the Wednesday after the City Council meeting of each month for approximately
three hours in the morning during school hours. In addition, the CYC members will be involved in a
variety of community events and meetings with some being overnight trips.

Based on the commitments you have already made or plan to make for the upcoming school year, could you dedicate the necessary time per month to the Carrollton Youth Council?

YesNo

Do you foresee any conflicts with the schedule? If so, what conflicts do you anticipate?

I,Name , verify that the information that I have included on the application is
correct to the best of my knowledge. I am interested in serving my community on the Carrollton Youth
Council and if selected, I will abide by all the rules and regulations set forth by the Carrollton Youth
Council, Mayor, City Manager, and City Council.

Student Signature

Date