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<br />c... C8U181. .8.111 C...'SSi8. <br />AI'I'IIIC 1118111 181.. <br /> <br />Middle Initial <br /> <br />Home Phone <br /> <br />Name: Last <br />Name you prefer to be called <br />Grade in school (2005-06): _10 _11 _12 E-mail Address <br />School <br />Home address <br />City <br />Parents/Guardians <br />Parents/Guardians daytime phone (in case of emergency) <br />Were you referred by: _Parent _School Personnel_Word of Mouth _Media _Alumni <br />_Other (please specify) <br /> <br />First <br /> <br />State _Zip <br /> <br />1. Why are you applying for the Cass County Youth Commission? <br /> <br />2. How do you think your involvement in the Cass County Youth Commission will help you impact the <br />future of your Community? <br /> <br />3. Describe an issue/concern currently facing your community. Explain how having leadership skills might <br />help you make a difference in the situation. <br /> <br />4. Name an individual that, in your mind, you see as a leader and why you see this person as a role <br />model. Also, what qualities in yourself mirror some of the qualities you see in this person? <br />