FCCLA OFFICER USE ONLY Member Fee $25 per person (Includes FCCLA T-Shirt) J. FRANK DOBIE HIGH SCHOOL ($9 national fee, $7 state fee, Partial T-Shirt fee) Paid Dues: $______FCCLA MEMBER APPLICATION Date: ______T-Shirt Size: ______2015-2016 Treasurer Initial: ______Co-Sponsor Initial: ______Section below to be completed by Student ID#: ______Name: ______Grade: ______Date of Birth: ______Age: ______Adult T-shirt Size: ______Address: ______Cell #: ______Can FCCLA send you text messages? (yes or no) Employer: ______Position: ______# of hours you work per week: __

Family and Consumer Sciences (FCS) Course(s) taken and/or currently in: (Principles of Human Services/Child Development/Nutrition and Wellness/Family and Community Services/Principles of Hospitality and Tourism/Hospitality/Fashion Design/Interior Design/Ready, Set, Teach) FACS Class Taken/Currently In: ______Semester/Year: ______FACS Class Taken/Currently In: ______Semester/Year: ______FCS Class(es) you plan on taking next year: ______

Other Activity(s)/Club(s)/Sport(s)/Etc. you are currently involved in (Both in and outside of school): ______

Write a statement on why you want to be a FCCLA member (1-2 sentences): ______

List at least (3) things you would like this organization to be a part of, visit, and/or accomplish. (For example: service projects, field trips, special events, fundraisers, etc. Be sure to explain your answer): ______

List your strengths: ______List your weaknesses: ______List your (3) favorite types of candy: ______All FCCLA members are required to be in a FCCLA committee to gain the ultimate LEADERSHIP experience. Circle (1) committee you would be interested in being a part of. Social Committee Fundraising Committee Membership Committee Projects Committee Public Relations Committee

Student Signature: ______Date: ______Section below to be completed by Parent/Guardian Parent/Guardian Name (who you live with): ______Parent/Guardian Contact Number: ______Can FCCLA send you text messages? (yes or no) Does FCCLA have permission to post public photos or videos of your teen? This may include, but not limited to social media sites, webpages, newspapers, etc. (yes or no)

Parent/Guardian Signature: ______Date: ______1st Deadline: Thursday, October 8, 15. Member fee is $25 per person for the entire school year and includes a FCCLA T-Shirt. (Member fee pays for the $9 national fee, $7 state fee, and partial cost of your FCCLA T-Shirt. Dobie FCCLA will cover the other portion of the T-Shirt cost). Bring this completed form and your member fee to Mrs. Martinez in Room 230. *Pay on or before Thursday, October 8, 15 and receive a FREE FCCLA lanyard and an invitation to a Mega Lunch Pizza Party on Friday, October 9, 15.