Application for the

National Western Center Youth Action

Coalition
The National Western Center Youth Action Coalition will provide
an outlet for youth in the GES community to share their insight
and perspective on the National Western Center project. The
Youth Action Coalition will be an opportunity to advise and
collaborate with project partners and creators around the NWC.
The group will meet monthly to discuss ideas and share plans for
the project.
Please neatly write in pen or type the answers to each question to the best of your ability. The
application can be email to ______________________ or dropped off to __________________.
Please complete and submit this application by ​November 30​th 2018. ​If there are any questions
about the application or the Youth Action Coalition please contact
________________________.
Applications are due by Friday, November 30​th ​2018
Name:________________________________________________________________________

Address:______________________________________________________________________
_____________________________________________________________________________

Phone Number:_____________________ Email:_____________________________________

School:_______________________________________________________________________

Class (starting in Fall of 2018):

☐Freshman ☐Sophomore ☐Junior ☐Senior

Age:__________________

Signature:___________________________________________ Date:___________________

Parent or Guardian Signature:______________________________________________________

Name:____________________

Please answer the following questions to the best of your ability (use additional
space if needed).

1. Why do you want to serve on the National Western Center Youth Action Coalition?

a. What experience do you hope to gain from the National Western Center Youth
Action Coalition?

2. What issues do you feel are important to youth in your community?

Name:____________________

3. Have you ever served as a member on a council or committee? If so, what was your role?

4. What leadership experience or skills do you have?

a. Which of these experiences or skills are most important you? Why?

Please provide a teacher recommendation below:

Teacher Name: _________________________________________________________________

Email: _________________________________ Phone: _____________________________

Please circle one statement regarding the impression of the applicant:

Highly Recommend Recommend Recommend with Reservation Do Not Recommend

Explain:_______________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Teacher Signature:____________________________________ Date:________________