S P E A R F I S H

Community Coalition

Youth Empowerment Team Information Form

General Information Sheet

Name of Participant ______

Address ______

City ______State ______Zip ______

Cell phone (______) ______Email address ______

Name of High School or Middle School______

Parent / Guardian ______

Home Phone (____)______Grade in school: ______

A complete application will include:

•  General Information Sheet

•  General Questions 1-4

•  Signed Candidate Agreement

•  Signed Parent/Guardian Endorsement

These items may be mailed or dropped off to the Coalition office.

Mailing address:
Spearfish Community Coalition
Attn: Melissa Currier
PO Box 708
Spearfish, SD 57783 / Physical Address:
1930 North Ave, Ste. 2
Spearfish, SD 57783

General Questions (to be answered by youth on a separate piece of paper)

1)  Why do you want to serve on the Youth Empowerment Team? What are some of your goals for it?

2)  What leadership roles have you had in the past? What have you learned from them?

3)  What skills will you bring to the group?

4)  What are two issues related to having a positive community, free of drugs, alcohol and tobacco are important to youth in Spearfish that you think the Youth Empowerment Team should be involved with?

Parent/ Guardian Endorsement

Spearfish Community Coalition

Youth Empowerment Team

Name of Candidate: ______

Parent/ Guardian Name: ______

I, ______, support and endorse ______to be a member of the Youth Empowerment Team at the Spearfish community Coalition. I understand that participation in the YET requires the above candidate to attend the following, which will take place in Spearfish, SD or designated travel locations:

·  Attend 75% of Regular Meetings

·  Youth Leadership Summit (TBA)

·  Participate in at least 1 environmental scan (summer months included)

·  Attend 1 youth conference/training per year

·  Participate in at least 1 YET recruiting event

·  Active participant in fundraising activities for YET group

·  Red Ribbon Week activities, October

·  Festival of Lights Parade & Activities, December

·  Participate in 50% of YET sponsored activities

·  Safe Prom messages

·  Graduation messages

·  Some Saturdays/weekends throughout the year as determined by activities

·  Any other activities or events that the YET organizes that are applicable

I understand that my child has made this commitment to participating in the Youth Empowerment Team at Spearfish Community Coalition and also understand that these events may require me to provide or arrange for transportation for my child. I also support my child’s commitment to the YET by making an effort to have he/she attend all necessary events, meetings and conferences. I agree to discuss priority making with my child as a part of this commitment.

Parent/ Guardian Signature: ______

Date: ______

Candidate Agreement

Spearfish Community Coalition

Youth Empowerment Team

Name of Candidate: ______

I, ______, wish to be a member of the Youth Empowerment Team at the Spearfish Community Coalition. I understand that participation in the YET is a minimum ONE YEAR, appointed position of responsibility, and requires me to actively be present and attend the following, which will take place either in Spearfish or designated locations:

·  Attend 75% of Regular Meetings

·  Youth Leadership Summit (TBA)

·  Participate in at least 1 environmental scan (summer months included)

·  Attend 1 youth conference/training per year

·  Participate in at least 1 YET recruiting event

·  Active participant in fundraising activities for YET group

·  Red Ribbon Week activities, October

·  Festival of Lights Parade & Activities, December

·  Participate in 50% of YET sponsored activities

·  Safe Prom messages

·  Graduation messages

·  Some Saturdays/weekends throughout the year as determined by activities

·  Any other activities or events that the YET organizes that are applicable

I understand that I am making this commitment to participate in the YET. I also understand that I may be responsible to prepare projects or reflections over the course of the year. My commitment is to making the Spearfish community drug and alcohol free and to develop a safe and positive community. I agree to be drug, alcohol, and tobacco free and a role model for my peers. I agree to give back to my community through various service learning projects and events.

Candidate Signature: ______

Date: ______

1930 North Ave, Ste. 2 / PO Box 708, Spearfish, SD 57783

 605.717.1417 | SpearfishCommunityCoalition.com