Applicant information

First name

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Last name

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Phone

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Phone type
Email address

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Address

Address

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Apartment, suite, etc. (optional)
City

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Country/region

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State

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ZIP code

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Date of birth

Month

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Day

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Year

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A.

General Information

Please fill out the questions below.

Gender

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Current School

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Current Classification

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How did you hear about the Youth Advisory Board at Little Light House?

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B.

Personal Information

Please answer each question fully in a maximum of 4 sentences.

Tell us a bit about yourself! (What do you do for fun? What are you passionate about?)

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Why are you interested becoming a member of the Youth Advisory Board (YAB) at Little Light House?

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Briefly explain your experience with or serving the special needs community.

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What skills and ideas could you bring to the YAB?

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What other organizations or groups have you been involved in or plan to be involved in?

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Is there any other relevant information you would like to share?

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C.

Reference 1

Please provide a contact for either a school, church, or professional reference. (Ex: teacher, coach, minister, boss). **They cannot be a family member or peer.

Name

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Relationship

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Phone Number

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Email Address

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D.

Reference 2

Please provide an additional contact for either a school, church, or professional reference. (Ex: teacher, coach, minister, boss). **They cannot be a family member or peer.

Name

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Relationship

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Phone Number

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Email

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