2023-2024 YMC Board Member ApplicationPlease be assured that the following information is used to ensure diversity and is kept confidential.First Name(Required) Last Name(Required) Prefered Name If you go by a different name besides your legal namePronouns(Required) (i.e., He/Him/El, She/Her/Ella, They/Them etc.)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Email(Required) Preffered Phone(Required)Age(Required)Date of Birth(Required) (##/##/####)Parent/Gaurdian Name(Required) First Last Parent/Guardian Phone Number(Required)Language Spoken at Home(Required) Where you a YMC Member before?(Required)NoYesWill you be an enrolled student for the 2022/2023 School year?(Required)NoYes(Enrollment in school is NOT a YMC requirement)If you will be a student for the 2023/2024 school year, what is the name of the school?(Required) How did you learn about YMC?(Required) What grade/year will you be in?(Required) Do you have any dietary restrictions?(Required) Vegetarian, vegan, lactose intolerant, food allergies? etc.Annual Family Income(Required)$0-$19,999$20,000-$44,999$45,000-$64,999$65,000-$84,999$85,000-$99,999$100,000-$200,000$200,000+Decline to State(confidential)Number of People in Household(Required)Race(s)/Ethnicity(Required) Hispanic/Latino?(Required)NoYesSexual Orientation(Required)Heterosexual/StraightHomosexaul/GayBisexualAsexualPrefer not to answerOther (write below)(confidential)Gender(Required) (Transgender, nonbinary, genderfluid, male, female etc.)Why do you want to be a part of the Youth Making Change board?(Required)Our goal at YMC is to establish a board that reflects the diversity of teens in Santa Barbara County. Those on the board are selected from different neighborhoods, academic levels, life experiences, etc. What perspectives do you feel you could bring to YMC? Please describe why/how you have those perspectives and why it is important for those teen perspectives to be heard? (Please share only what you feel comfortable sharing)(Required)Please describe one significant event, person, or experience that has helped make you the person that you are today(Required)What do you think are the biggest problems facing teenagers in your community? What do you think is/are the cause's(Required)What can be done to fix/solve the above problem(s)?(Required)Please list any school clubs, sports, community groups and/or work you will be involved in (or think you will be involved in) from August 2022 to May 2023. (involvement in activities is NOT a requirement to serve on YMC)(Required)Feel free to use bullet points with (-) i.e., - Future Leaders of America - Tennis - Las Comadres Club - Latinos UnidosYMC Meetings take place on Wednesday (Santa Maria) or Thursdays (Santa Barbara) from 6:00 pm - 8:00 pm. Will any activity conflict with YMC meetings?(Required)NoYesConsent(Required) I agree to the commitmentI understand the purpose and function of the YMC program. I am aware of the mission and goals, and if accepted, I am prepared to fulfill the commitment that is asked of all members. I commit to attending meetings, trainings, and retreats as outlined in the YMC information packet and as determined by YMC board members. I understand that the time commitment includes monthly board meetings, some weekend meetings, and three Saturday meetings. I have also discussed the time and travel commitment with my parent(s) or legal guardian(s) teachers and school administration, sports coaches and other activity directors, employers, and all others who may be affected by my involvement with the YMC Board.Consent(Required) I the parent/legal guardian agree to the commitment statementI, the parent/legal guardian/significant adult for the youth applying, understand and support the mission and goals of Youth Making Change, support my student's commitment, and give my permission for full participation in all activities and responsibilities required of a YMC Board member. Yo, la madre/el padre/el tutor/adulto significante del applicante, entiendo y apoyo la mision y las metas de YMC, la/lo apoyo en este compormiso, y le doy el permiso para participar completamente en todas las actividades y responsabilidades requeridas de un miembro del consejo de YMC. Δ
