Name
Address
Phone Number
Email
School Attending
Current Grade
Date of Birth
Name of Parent/Guardian
Are you a City of Portage resident?Yes
No
Besides school, what other activities do you participate in (e.g., sports, volunteer/paid work, drama, etc.)?
Why are you interested in participating in the Youth in Government Program?
What unique perspective are you able to offer if selected to participate on the Youth Advisory Committe or as a Youth Participant to a Board, Commission or Committee?
Which area(s) are you interested in serving on? (You may check more than one.)Youth Advisory Committee
Youth Participant to Environmental Board
Youth Participant to the Historic District Commission
Youth Participant to the Human Services Board
Youth Participant to the Park Board
Youth Participant to the Senior Center Advisory Board