4. La Vista Youth Leadership Council Application
6. Our mission is to build the future of La Vista by strengthening our youth.
8. Date*
10. Applicant's Name*
    First M.I. Last
12. Street address*
14. City*
15. State*
16. ZIP*
18. Phone number*
20. E-mail address*
22. Date of Birth*
    Date of Birth
24. School and grade level in which you are currently enrolled.*
26. Please provide three references including at least one from an organization in La Vista.
    (References may not be family members or Youth Leadership Council sponsors.
28. Name & Organization*
29. Address & Phone Number*
31. Name & Organization*
32. Address & Phone Number*
34. Name & Organization*
35. Address & Phone Number*
37. Please list all school, community, sports and other organizations in which you participate or volunteer.*
39. Please list one of the most important issues in your neighborhood on which you like to focus.*
41. Write a brief explanation of how you can address the concern listed above effectively with La Vista agencies and residents.*
43. Write a brief explanation of your experience and involvement in the community or school that has prepared you for representing your neighborhood in facilitating meetings, listening to the concerns of peers, communicating information about youth programs, working to develop innovative solutions and meeting with community leaders.*
45. How will you demonstrate commitment to working with partners, visiting youth agencies, attending citywide meetings, conducting neighborhood meetings and carrying out other responsibilities of council membership?*
47. Please type your name below, which will serve as your signature.*
48. Date*
50. Parent or guardian permission is required to apply for the La Vista Youth Leadership Council. You will be asked to obtain the signature of a parent or guardian.
Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit

* indicates a required field