Application for Youth Advisory Council


Please submit your information by filling out the form below.
Required Fields are indicated in red



  Last Name
Address

City State Zip Code
Are you a resident of the City of Rockwall?
Home Phone
(000) 000 - 0000
Cell Phone
(000) 000-0000
 
 
School
Grade Age Date of Birth
 
Clubs & Activities Involvement  
(please do NOT use single or double quotation marks in your entry)

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
kcole@rockwall.com

OR
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 )