YOUTH ADVISORY COUNCIL APPLICATION

"We need to get behind the Meth Project and give it our full support. This is a chance to make a real difference in our state."

Max Baucus
U.S. Senator

Fields marked with an asterisk ( * ) denote required fields.

YOUR NAME

First Name * MI

Last Name *

YOUR CONTACT INFO

Address Line 1 *

City *

State MT

Zip or Postal Code *

Email Address *

Re-Enter Email Address *

Phone *

Cell Phone

SHIPPING ADDRESS

If your shipping address is different then above, please enter it here.

Shipping Address

City

State MT

Zip

OTHER INFORMATION

Birth Date *

Grade * (2009-2010 school year)

Name of School * (spell out)

City School is in *

QUESTIONS

You will need to have access to email and the internet for this position. You will also need to have on your computer (or have access to) Microsoft Office programs like Word, Excel and PowerPoint (or programs that are compatible) and tools that we will provide you as a council member.

Please answer the following questions in 200 words or less (Do not use return key when answering the questions. Use the tab key to toggle to next answer):

If you do not have these programs, would you be willing and able to purchase them if chosen? * Yes No

In what Montana Meth Project activities have you been involved in the past, if any? *

Why is being a Youth Advisory Council Member for the Montana Meth Project important to you? *

What types of activities would you like to see the Youth Advisory Council be involved in? *

What skills would you hope to gain or enhance by being a MMP Youth Advisory Council member? *

We're looking for a diverse group of students to bring a variety of skills to this council. What are the three biggest strengths or skills you would bring to the Youth Advisory Council? (Some examples: artistic skills such as drawing, painting, design, writing, music, video, etc.; computer skills, speech/debate, participation in other community or school groups/organizations/teams, leadership experience) *

Have you or a family member been affected by Meth? Yes No

Travel will be involved for the Youth Advisory Council. Do you have a driver's license or an adult who can provide transportation? * Yes No

PARENT/GUARDIAN INFORMATION

First Name * MI

Last Name *

Mailing Address

City

State

Zip or Postal Code

Parent Email Address *

Re-Enter Email Address *

Phone *

Cell Phone