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Application for Youth Advisory Council

If you prefer, you can print out a hardcopy version of this application and email or fax it to The Media Center.

If you have questions, please feel free to contact Danielle Fairbairn, Youth Services Coordinator at (650) 494-8686 ext. 37 or Danielle@CommunityMediaCenter.net.

Contact Information

First Name

Last Name

Birth Date

Address

City

Zip

Home Phone

Cell Phone

Email Address

School

Age

School

Freshman
Sophomore
Junior
Senior

Year to Graduate

Availability Check all that apply.
Monday 5:30-7:00pm
Tuesday 5:30-7:00pm
Wednesday 5:30-7:00pm
Thursday 5:30-7:00pm
Other:

Activities/Experience

Please list any past or present extracurricular activites in which you participate:

Do you have any previous media production experience?
If so, what? (No experience is necessary.)

If you have media experience,
are you interested in becoming a Group Leader?

Essay Please answer ONE of the following questions:

Why are you interested in joining YAC, and what can you bring to the group?
How can you use video/media to create change in your community?
If you could make a video, what would it be about?

The essay is required to complete the application. However, you may submit this separately at a later time by emailing it to Danielle@CommunityMediaCenter.net.

"Producing at the Media Center has allowed me to be a part of the community in a way that helps others. It's opened endless doors of opportunities and most importantly it's been a vehicle of service to the community."

Andrea Throndson
Producer,
"Everyone's Yoga"