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2. First Name*
3. Last Name*
5. Address1*
7. Address2
9. City*
10. State*
11. Zip*
13. Telephone (home/cell)*
14. Email Address*
15. Date of Birth*
17. Race/Ethnicity*
18. Gender Identification
19. Age*
20. School*
22. Grade Level for 2022-23 School Year*
23. Name of School*
    If homeschool, type "Homeschool"
25. What qualifies you to be a member of the Youth Advisory Board*

    1. Reside in Carrboro
    2. Go to school in Carrboro
    3. Work in Carrboro

    Check all that apply.
27. Parent/Guardian Name*
28. Telephone*
30. Parent E-mail*
32. By applying for the Youth Advisory Board, I recognize there will be a mutually agreed upon one (1) meeting per month which will require my attendance. I am able to commit to this time requirement.*
    Type your full name.
34. What other activities do you participate in at school or outside of school? We want to understand your interests and your current time commitments. Please include work, clubs, sports, and volunteer roles you may play at school or in the community.*
36. Reasons you wish to be appointed*
38. What Town issues do you believe are important to youth in Carrboro?*
40. (Please note that this document and the information contained on it is a public record and must be provided by the town to anyone requesting a copy of it.)
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field