Contact & Personal InformationName* First Last Date of Birth* MM DD YYYY What is your current education level or status?*High school FreshmanHigh school SophomoreHigh school JuniorHigh school SeniorCollege FreshmanCollege SophomoreCollege JuniorCollege SeniorOTHER- Not currently in school, Working full Time, Gap Year, Working Part Time/ School Part TimeWhich gender do you identify as?* Male Female Non-Binary Gender Fluid Other Do you identify with any of these groups? Choose all that apply.* LGBTQ+ Military personnel or child of a veteran Person with a visible or non-visible disability Person receiving Department of Children’s & Families (DCF) support Not applicable Race/Ethnicity*Black / African AmericanHispanic / LatinxMulti RacialAsianNative Hawaiian or Pacific HighlanderAmerican Indian/Alaskan NativeWhiteHome Information* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell Phone*Email* Do you have access to your own computer where you can actively participate, do research, and create presentations? We will be using applications such as: Google Slides/Powerpoint, Google Docs, Google Classroom and Zoom.*YesNoDo you have access to wifi/internet?*YesNoWho is your civic superhero? Why are they your civic superhero?*What are your top 3 civic concerns for Trenton, and what do you hope to see change over the next 2-5 years? Explain.*Do you have any experience working on projects to improve your community? If yes, please explain what you did. Examples: volunteering at your local community centers or creating a new club in your school.*Please list any special skills or interests you have that you would like to bring to the MIllHill Youth Council.*We will meet virtually, biweekly, via Zoom on Thursdays from 4-6 pm. Are you able to commit to these meetings and any additional research or project time outside of the 2 hour meetings?*YesNoReferencesPlease provide 2 references; FIRST AND LAST NAME, PHONE NUMBER AND EMAIL (Suggested References: Educators, Guidance Counselors, Advisors, Coaches) Reference #1*First NameLast NamePhone NumberEmail Reference #2*First NameLast NamePhone NumberEmail Upload Resume*Please upload your completed resume as a PDF or Microsoft Word document. You will NOT be able to complete your application without a resume. * View a sample resume for guidance: .doc / .pdfAccepted file types: pdf, doc, docx.Are you over 18 years of age?*YesNoAgreement & Consent As a program participant I agree to demonstrate respect for all staff, volunteers, and colleagues in this program. I will do my best at all times to model responsible behavior throughout the program. If I act disrespectful, impolite, dress inappropriately at any time during the program, I may be asked to leave the program. As a Millhill Youth Advisory Council member, I am aware that I am a role model and will behave accordingly. Photo and Video consentI agree to be photographed/filmed at activities related to the Millhill Youth Council. I understand that these photos/videos may be used for Millhill newsletters, publications, media publicity, including social media.I do not give permission to be photographed/filmed at activities related to the Millhill Youth Council.*Please use your cursor/mouse or finger (if you're on a phone or tablet) to sign in the space provided above.Parent /Guardian Info (required if applicant is under 18)Parent / Guardian Information* If you are under the age of 18, a parent's signature is required to participate in the MHYAC. First Last Parent Email* Parent/Legal Guardian Cell*Please select your annual household income range.*Up to $20,000$20,000 - $30,000$30,000 - $40,000$40,000 - $50,000$50,000 - $60,000$60,000 - $75,000$75,000 – 100,000$100,000+Photo and Video consentI agree to have my child photographed/filmed at activities related to the Millhill Youth Council. I understand that these photos/videos may beused for Millhill newsletters, publications, media publicity, including social media.I do not give permission to have my child photographed/filmed at activities related to the Millhill Youth Council.Signature of Parent / Legal Guardian*Please use your cursor/mouse or finger (if you're on a phone or tablet) to sign in the space provided above. By signing, you grant permission for your child to participate in the Millhill Youth Advisory Council.EmailThis field is for validation purposes and should be left unchanged.