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4. Lewiston Youth Advisory Council 2022- 2023 Application

   Deadline for Application Submission: 4:00 p.m. on Friday, May 13, 2022.

6. 
7. SUBMIT ONLINE BELOW OR YOU MAY PRINT AND MAIL TO: City Administrator's Office, Lewiston City Hall, 27 Pine Street, Lewiston, ME 04240.
9. Eligibility
   To be considered for membership on the City of Lewiston Youth Advisory Council, an individual must be a Lewiston resident at the time of application OR a student (or will be in the fall) at either Lewiston High School or St. Dominic Academy.
11. To Learn More About LYAC
    LYAC Web Page
13. Statement of Purpose - Lewiston Youth Advisory Council (LYAC)
    “The LYAC shall serve as an advisory council to the Lewiston City Council in regards to community issues affecting youth and shall serve as a liaison between the youth of the community and the City. The LYAC shall enable youth to work toward goals that empower all of the community’s youth and to undertake service projects that enhance the community.”
15. First Name*
16. Last Name*
18. Date of Birth*
20. Grade*
21. School or Home School Affiliation*
23. Home Address*
25. Phone Number*
26. Email Address*
28. Parent / Guardian Name*
29. Parent / Guardian Phone Number*
31. Why do you want to serve on the 2022 - 2023 Youth Advisory Council?*

    In addition to answering the above "why do you want to serve" question, feel free to include other information about yourself that you believe may be helpful to the Selection Committee regarding your ability to serve.

33. Commitment to Serve (By Signing Application, Applicant Agrees to This)
    “If selected to serve on the Lewiston Youth Advisory Council, I agree to work in a spirit of teamwork with my fellow peers, the LYAC Advisor, other members of the LYAC, 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.”
35. Electronic Signature*
37. Please Provide Three References (NOT A RELATIVE)
41. Reference Name*
42. Reference Affiliation*
44. Reference Contact Information*
48. Reference Name*
49. Reference Affiliation*
51. Reference Contact Information*
55. Reference Name*
56. Reference Affiliation*
58. Reference Contact Information*
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62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field