YAC Membership Application APPLICANTS MUST BE AT LEAST 16 YEARS OLD. All fields with an asterisk(*) are required. APPLICANT INFORMATION Full Name*: Address*: Apt/Unit#: City*: State*: Zip*: Phone*: Email*: Have you ever worked for Bright Minds?* YesNo If yes, how many years? EDUCATION High School*: Address*: GPA: Did you graduate? YesNo If not, grade level? College: Address: College GPA: Did you graduate? YesNo If you graduated, Degree? Click one, if applicable: FreshmanSophomoreJuniorSenior REFERENCES Please list professional references. Reference 1 Full Name*: Relationship*: Company*: Phone*: Address*: Reference 2 Full Name*: Relationship*: Company*: Phone: Address*: SHORT ANSWERS What qualities can you bring to the BMYD Youth Advisory Council?* What do you hope to gain from this experience?* DISCLAIMER AND SIGNATURE I certify that my answers are true and complete to the best of my knowledge. I agree to adhere to attendance policies, implement duties and responsibilities, and commit my membership to a full term (June-July). Signature*: Date*: (By entering your name, you agree to accept the terms of the above document with an electronic signature.) Question, comments, concerns? Please do not hesitate to contact: Alexus Williamson | Youth Advisory Council Coordinator| [email protected]