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 Broomfield FISH Youth Advisory Board (YAB) Application Board Term May 2015­May 2016 (grades 7th­12th) The completed application is due to ​Broomfield FISH​ (26 Garden Center, Suite 1, Broomfield, CO 80020) on or before March 31, 2015. ​ If you have any question please contact Stacey Schmuck at [email protected]​. ​I understand that completing this form does not guarantee selection to Broomfield FISH YAB and that the information presented here is accurate and complete. Student Name:_____________________________ Current Grade:_______________ Parent/Guardian Name:___________________________________________________ Address:_______________________________________________________________ Phone:_________________ Email:__________________________________________ Teacher/Community Recommendation: I recommend the above student for membership in the Broomfield FISH Youth Advisory Board. Name:____________________________________ Organization:_________________________________ Signature:_____________________________________________________________________________ SCHOOL ACTIVITIES​­List activities you have been involved in at school. List any leadership positions or accomplishments. Activity:_________________________________ Grade level at the time:________________ Accomplishments:_______________________________________________________________________
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_______________________________________ Activity:_________________________________ Grade level at the time:________________ Accomplishments:_______________________________________________________________________
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_______________________________________ COMMUNITY PARTICIPATION​­List involvement in community activities noting any leadership roles or accomplishments. Activity:_________________________________ Grade level at the time:________________ Accomplishments:_______________________________________________________________________
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_______________________________________ Activity:_________________________________ Grade level at the time:________________ Accomplishments:_______________________________________________________________________
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______________________________________________________________________________________ Activity:_________________________________ Grade level at the time:________________ Accomplishments:_______________________________________________________________________
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_______________________________________ OTHER​­List job/volunteer experience. Job/Volunteer Experience:___________________________ Grade level at the time:________________ Details:________________________________________________________________________________
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______________________________________________________________________________________ Activity/Award:___________________________ Grade level at the time:________________ Details:________________________________________________________________________________
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______________________________________________________________________________________ Activity/Award:___________________________ Grade level at the time:________________ Details:________________________________________________________________________________
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______________________________________________________________________________________ Why would you like to become a member of Broomfield FISH’s youth advisory board (YAB)?​________________________________________________________________________________
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____________________________________ Student Signature: Please confirm that you have read the Youth Advisory Board requirements and are able to make the full commitment for the entire term. Student Signature:________________________________________________ Date:__________________ Parent/Guardian Signature: Parent Signature:_________________________________________________ Date:__________________