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YAC Application

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Name (First, Middle, Last)
Street Address
City
Zip
Home Phone:
Cell Phone:
Email Address
Birth Date:
School Attending:
Grade:

What activities have you been involved in the community?

What extracurricular activities do you participate in throughout the year?

What qualities, skills and resources would you bring to the YAC?

What areas of interest would you want the Council to work out?

What would you consider to be your strengths?

What do you hope to accomplish by joining the YAC?

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