Mayor's Youth Council Application
Students in grades 8th thru 11th can apply. Students must be residents of the City of Knoxville.
Applications will be accepted until May 19, 2023. Term will begin in August of 2023. |
| PERSONAL INFORMATION |
Full Name
|
Preferred Name
|
Email Address
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Age
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Date of Birth
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Gender
Male Female Other/Non-binary Prefer Not to Say |
Race
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Street Address
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City, State, Zip Code
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Home Phone #
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Cell or Alternate Phone # (if available)
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Preferrred Method of Contact
Phone Call Text Email |
What times are you (student) available to be contacted?
Morning Noon Evenings |
| SCHOOL INFORMATION |
Name of School
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Grade
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Current GPA
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| GUARDIAN & EMERGENCY INFORMATION |
Guardian Contact Number
Guardian Email Address
|
Student Emergency Contact Name
Student Emergency Contact Number
|
| ACTIVITIES |
What issues are you passionate about? Please include related extracurricular activities.
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Are you involved in any other extracurricular activities such as sports, clubs, teams, etc.
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How did you hear about the Council?
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| REFERENCES |
| Please list two references. At least one should be 21 years or older. |
Reference #1 Name
Phone
Street Address
City, State, Zip Code
Email Address
|
Reference #2 Name
Phone
Street Address
City, State, Zip Code
Email Address
|
| PERMISSION |
| I give my child permission to participate in the Empower Knox Mayor's Youth Council and for the City of Knoxville to take photos that may be used in the media. |
Guardian Consent
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Applicant Signature
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