NAME:    
         Title		First		Middle		Last		Nickname 

HOME ADDRESS:    
                 Street		City		State			Zip 

HOME PHONE:                  Fax:     Email:    

ARE YOU A STUDENT?  YesNo IF SO WHERE?

GRADE:                           GPA:      

EMERGENCY CONTACT:    PHONE:    

RELATIONSHIP:         

YOUR EDUCATION:  please write-in number of years you attended: 


High School or equivalent:    College:    Graduate School:    
                Doctorate:      Other:     

DEGREE OR TRADE OBTAINED:    

AVAILABILITY
PLEASE LIST THE HOURS YOU ARE AVAILABLE TO ATTEND MEETINGS WITH THE YOUTH ADVISORY BOARD:  


Monday:        Friday:    
Tuesday:        Saturday:    
Wednesday:        Sunday:    
Thursday:        

Comments:    

If you are requesting to do a student internship with us, please specify the number of hours required:     

Please list any special interests, hobbies, etc.:     

Do you speak of foreign language?   YesNo   Please be specific:    

Do you know American Sign Language?  YesNo

Why are you interested in becoming a member of the High Voltage Youth Camp Advisory Board at this time? 


Have you ever volunteering in the past?  YesNo

If yes, please describe your favorite and least favorite experience and what you liked/disliked about each: 


Please list three people who you have known for 3 or more years 
who would be willing to serve as personal references (No relatives, please): 


Name:    

Phone Number:     Email:    

Relationship:    How long have they known you?    

Name:    

Phone Number:     Email:    

Relationship:    How long have they known you?    

Name:    

Phone Number:     Email:    

Relationship:    How long have they known you?