Youth in Government Application

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					                Youth in Government Application

Please type or print the following information. Return completed application to the City of Hurst
by September 17, 2010:

   Name:                                                              Date:

   Address:                                                           Phone:

   School:                                                            Grade:

   Grade Point Average:                                 Grade Point Scale:

   Email Address:

   What are you involved in? (i.e. Clubs, Athletics, etc. inside/outside school):

   Future Aspirations:

   Briefly explain why you are interested in the Youth in Government Program:

   Are there any conflicts with your schedule that would prevent you from attending meetings
   once a month on a Thursday afternoon or evening?

   How did you find out about the Youth in Government Program?

   Return this form to:
   Youth in Government, c/o Ashleigh Whiteman,
   1505 Precinct Line Rd.
   Hurst, TX 76054