Office of U.S. Congressman Sam Johnson

APPLICATION FOR THE 2006-2007 CONGRESSIONAL YOUTH ADVISORY COUNCIL Only completed applications will be considered. Applicants must be enrolled in 9th, 10th, 11th, or 12th grades. Please print or type all of the requested information. Attach additional sheets if necessary. Applicant’s name: ______Current grade level______Home address:

______Home phone number:______cell phone:______

Email ______Age ______DOB ______Alternate email______If over 18, are you a registered voter? ______Did you apply to the Council last year?______If yes, were you selected______What school do you attend?______Class rank ______Cumulative grade point average ______List all clubs and activities:______Would you be able to meet on Monday evenings from 5:30pm – 7:30pm and / or Saturday mornings from 10:00am to noon – which would you prefer? Please circle MON PM SAT AM What topics and/or speakers would most interest you?______Do you have any relatives who are federal, state or city employees, members of a city council, or serve on any board or commission? (If yes, please list.) ______* * Please include a letter of parental permission to participate. * * Please include a current photo of yourself for identification purposes only. * * In 250 words, briefly state what you would like to achieve by serving on the Congressional Youth Advisory Council. (Please type or clearly hand-write your answer on a separate page.) * * Please attach at least two letters of recommendation from a teacher, counselor, principal, mentor or community leader with this application. Please submit the completed application and related paperwork to the Office of Congressman Sam Johnson by September 15th. In person or via mail: Office of U.S. Congressman Sam Johnson C/O Susan Fischer 2929 North Central Expressway, Suite 240 Richardson, Texas 75080 *Questions about this application? Please call (972)470-0892.