Student Civic Leadership Program
Contact Information
Prefix:
*
First Name:
*
Last Name:
*
Email Address:
*
Street Address:
*
Street Address: (Continued)
City:
*
State:
*
--- Please Select One ---
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
AA
AE
AP
FM
GU
MH
MP
PR
VI
AS
Zip Code:
*
Phone Number:
*
School:
Grade:
Are you able to commit to monthly meetings for the duration of the program, given health provision allows?
What is your availability to meet?
Have you served in a student advisory role before?
What is your top policy focus (education, public safety, immigration, housing, environment, civil liberties, technology, health,) list three ranked by order of interest.
ESSAY QUESTIONS
Please write a brief paragraph about yourself, your skillset, and the reasons you would like to be a civil leader.
Provide us an example of either a young person or group of young people that has become civically engaged...
Tell us about a time you experienced or witnessed a conflict. How did you handle it?
Please tell us about your policy interests and why they are important to you.