Adult Advisor Job Description

Philanthropy Board in Jackson County (PBnJ)

Youth Board Application Form

Name: ___________________________________________________________ Age: ___________

Home address: _____________________________________________________________________

(Number & Street) (City) (State) (Zip)

Home phone: (_____) ___________________ Cell phone: (_____) ___________________

E-mail: _______________________________ Do you have a Facebook account? Yes No

If yes, what is your Facebook name________________

Parent(s)/Guardian(s) name(s): _________________________________________________________

School: ______________________________________________ Circle grade: Junior Senior

School and community activities/Organizations and leadership positions:

_________________________________________________________________________________

Community service/organizations and leadership positions:

_________________________________________________________________________________

Why would you like to serve on the Youth Advisory Board?

__________________________________________________________________________________

What will you bring to the Youth Advisory Board?

__________________________________________________________________________________

ADDITIONAL COMMENTS FOR THE ABOVE MAY BE WRITTEN ON THE BACK OF THIS SHEET OR ATTACH AN ADDITIONAL SHEET

Philanthropy Board in Jackson County (PBnJ)

Youth Board Application Requirements

1. A personal letter of recommendation, please include the recommendation form also (i.e. from a teacher, counselor, employer, minister/priest, etc.).

2. Attendance at monthly scheduled meetings and a one day retreat. Meetings will be held the following dates 1:00-3:00 p.m. at the Jackson County Extension Office (basement of the Courthouse):

September 21st

October 12th

November 9th

December 14th

January 11th

February 8th

March 14th

April 11th

A retreat will be scheduled at a later date, to be held during Winter Break.

______________________________________________________________________

PLEASE RETURN ALL MATERIALS BY 4:00 P.M., September 19, 2011 T0:

ISU Extension Office or Community Foundation of Jackson County

Amber Matthiesen Angie Petit

201 W. Platt St. 120 ½ S. Main St.

Maquoketa, IA 52060 Maquoketa, IA 52060

Phone: 563-652-4923 Phone: 563/652-4179

Fax: 563-652-6710 Fax: 563/652-4203

Email: Email:

Signature _________________________________________Date____________

Parent’s Signature __________________________________ Date ___________

The Youth Philanthropy Board in Jackson County is a joint project of the Community Foundation of Jackson County and the Iowa State University Extension, Jackson County. If you have any questions, please contact Angela Petit at 563-652-4179 or Amber Matthiesen at 563-652-4923

RECOMMENDATION FOR APPLICATION TO THE YOUTH PHILANTHROPY BOARD IN JACKSON COUNTY (PBnJ)

Applicant Name ______________________________________________________________

Name of Person Submitting Recommendation_______________________________________

Relationship to Applicant________________________________________________________

The above-named student is applying to the Youth Philanthropy Board in Jackson County. PBnJ promotes volunteerism and philanthropy among youth in the Jackson County area. Each year, PBnJ will award grants. We would greatly appreciate your help in our selection process. Please evaluate this student, particularly her/his sensitivity and tolerance, concern for others, potential for leadership, energy, and sense of responsibility. Include specific examples if appropriate. Junior and senior youth will be selected to represent each Jackson County school. THIS RECOMMENDATION IS DUE AT THE COMMUNITY FOUNDATION OFFICE OR ISU EXTENSION OFFICE BY 4:00 p.m., September 19, 2011.

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