District of Columbia Student Leadership Application

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Last Name, First Name, M.I. *

Date of Birthday (XX-XX-XXXX) *

Street Address , Apt/Unit #, City, State Zip *

Cellular Phone Number (XXX-XXX-XXXX) *

Home Phone Number (XXX-XXX-XXXX) *

Email Address *

Are you a Resident of the District of Columbia? *

Yes

Required

Name of high school you attend *

Other High School(s) Attended

Year of Graduation *

What is your current GPA? *

What are position are you applying to serve on for the State Board of Education? *

I am applying to the State Board of Education Student Representative ONLY

I am applying to the State Board of Education Student Advisory Committee Member ONLY

I am applying for either of the positions available.

Educational-Related Extracurricular Activities *

Please list ALL school related extracurricular activities, past and present. List Activity first then, Date Start and Date End.

Community-Related Extracurricular Activities *

Please List ALL Community related extracurricular activities, past and present. List Activity first then, Date Start and Date End.

Awards and Recognitions *

Please list ALL awards, past, and present. List Award first the, Date Received

ESSAY: Write a 500 word essay explaining WHY I WOULD LIKE TO SERVE ON THE STATE BOARD OF EDUCATION *

Letters of Recommendation Information- One from someone within your school and one from someone outside of your school *

Please provide the names, phone numbers and emails of the people who will be completing your recommendation letters

Disclaimer and Signature. Use Signature font, your first and last name and the date. *

I certify that my answers are true and complete to the best of my knowledge. If this application leads to a Student Representative position or a Student Advisory position for the District of Columbia State Board of Education, I understand that false or misleading information in my application or interview may result in my release.

I understand that this position requires me to, at minimum, attend and actively participate in (eight) 8 hours per month in two (2) scheduled meetings *

Yes

Required

I understand that this position requires me to actively participate, engage, and exchange in Pubic activities including but not limited to (Public Meetings, Working Sessions, Webinars, Seminars, Community Engagement Opportunities, and Social Media) *

Yes

I understand that this position requires me to serve for a full school year. *

Yes

I understand that this position requires me to effectively communicate my perspective and questions on student educational issues before the State Board of Education. *

Yes

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