Submit Application by January16,
2006 to Either
Belfast City Clerk’s Office OR
Belfast Recreation and Parks Department,
131 Church Street, Belfast Maine 04915
(Word Document format available upon request)
BELFAST YOUTH COUNCIL
APPLICATION
Statement of Purpose- Belfast Youth Council (BYC)
“The Belfast Youth Council’s mission is to
create a working partnership among the youth of Belfast and the city
government, to ensure a better sense of community, responsibility and
service. Specifically, the purposes of the BYC are to enable Belfast youth
an opportunity to participate in municipal government as an advisory body,
and second, to utilize their creativity towards community enhancement.”
Name:
___________________________________________________________
Grade: ___________________________________________________________
Home Address:
____________________________________________________
Phone: ___________________________________________________________
E-Mail Address: ____________________________________________________
Parental/Guardian Contact number: _____________________________________
Why do you want to serve on the 2006-2007
Belfast Youth Council?
(In addition to answering the question,
feel free to include other information about yourself that you believe may
be helpful to the Screening Committee regarding your ability to serve.)
(For
additional space please Continue On Back of Form)
I wish to serve on the BYC because:
“Commitment
to Serve”
If selected to serve on
the Belfast Youth Council, I agree to work in a spirit of teamwork with my
fellow peers, the BYC Co-advisors, other members of the BYC, municipal
officials, municipal staff, and community members with the understanding
that I have been provided with a unique opportunity to represent my peers in
a positive light and effectively contribute on behalf of all youth within
our community.”
___________________________________________________________________
Applicant’s Signature
Signature of Two (2)
Supportive Adult Community Members (Non Relatives)
___________________________________________________________________
____________________________________________________________________
Signatures of ten (10) Supportive Peers
That May Include Friends, Neighbors and Classmates
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
For a word document copy of this application email:
Jim Bell, Director of Parks and Recreation
or
Roberta Fogg, City Clerk
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