YAC Application

Application for Youth Advisory Council

First Name:
Last Name:
Address:
City:	State:	Zip:	Are you a resident of Rockwall County?
Home Phone: (Numbers only, no dashes)	Cell Phone: (Numbers only, no dashes)
Email Address: (Leave As-Is if you don't have an email address)
School:

Grade:	Age:	Date of Birth: (MM/DD/YYYY)

Clubs & Activities Involvement: None
Briefly state why you're interested in YAC. List your reasons here...

Please submit at least one letter of recommendation from a teacher, counselor, principal or adult family friend with your application. You may scan and e-mail this letter to kashberry@rockwall.com, fax it to (972) 771-7727 or mail it to: Rockwall City Hall, Attention City Secretary, 385 South Goliad Street Rockwall, TX 75087. Participation requirements are part of the YAC program. Are you willing to commit to the time & effort required? (Check for Yes, leave blank for No: )

Internal Use only. DO NOT enter anything in this field.