Mayor's Youth Council Application Form



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Mayor's Youth Council
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 March 31, 2022.
PERSONAL INFORMATION
Full Name
Email Address
Age
Date of Birth
Gender
Male   Female
Race
Street Address
City, State, Zip Code
Home Phone #
Cell or Alternate Phone # (if available)
What times are you (student) available to be contacted?
Morning   Noon   Evenings
SCHOOL INFORMATION
Name of School
Grade
Current GPA
GUARDIAN & EMERGENCY INFORMATION
Guardian Contact Number
Student Emergency Contact Name

Student Emergency Contact Number
ACTIVITIES
What issues are you passionate about? Please include related extracurricular activities.
Are you involved in any other extracurricular activities such as sports, clubs, teams, etc.
How did you hear about the Council?
REFERENCES
Please list two references. At least one should be 21 years or older.
Reference #1 Name

Phone

Street Address

City, State, Zip Code
Reference #2 Name

Phone

Street Address

City, State, Zip Code
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
Applicant Signature


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