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* indicates a required field

2. Note:

   Applications are considered current for one-year term. Your application / biographical information will be copied for the City Council and made available to the press and public upon request.

4. Youth Advisory Commission Requirements
   • Must live in the City of Citrus Heights
   • Be enrolled in grades 8 through 12
   • Commit to attending Commission meetings at least once a month between September and May
6. Personal Data
8. First Name*
9. Last Name*
11. Home Address*
13. City*
14. State*
15. Zip*
17. Email Address*
18. Phone Number*
20. Are you a Citrus Heights resident?*

    1. Yes
    2. No
21. Are you able to attend monthly Commission meetings?*

    1. Yes
    2. No
23. What is your current grade level?*
    Enter the grade level you will be in when school begins this Fall.
24. What school will you attend in the Fall?*
    -- Select One --Mesa Verde High SchoolSan Juan High SchoolSylvan Middle SchoolKingswood K-8Lichen K-8Woodside K-8Other
26. Other school
28. Interests and Experiences
30. Why do you want to serve on the Youth Advisory Commission?*
32. Please list experience, community activities or other qualifications that would be helpful to the City Council in evaluating your application.*
34. What do you feel are the issues most greatly affecting youth in the City?*
36. Letter of Recommendation (Optional)

    Submit one, signed letter of recommendation from a teacher, advisor, counselor, or coach (or similar) with your application.

38. Applicant Acknowledgement*

    By submitting this form, I hereby verify that the information I have included on this application is accurate. All information provided is subject to verification. False, inaccurate, or ineligible applications will be disqualified.

    1. Please click here once you have read this statement.
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39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

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