Youth Leadership Council Application

Please submit your completed application by 5:00 pm CST on June 17th. If you have questions, please contact Project Extra Mile by calling 402-963-9047 or email us at youth@projectextramile.org. Thank you for your interest in the Youth Leadership Council!

First Name*

Last Name*

Address 1*

Address 2

City*

State*

Zip*

Phone Number*

Email Address*

School*

Grade Level in 2022-2023*

Referring Individual or Organization (if applicable)*

Write N/A if not applicable

Preferred Method of Communication (text or e-mail)*

Do you have any experience working on efforts to prevent alcohol, tobacco, and other drug use? If yes, please tell us about your experience.*

Which of the following areas interests you the most? Please select the two you find most interesting.

Policy Initiatives – working to advocate for stronger alcohol policies in Nebraska Enforcement Collaborations – partnering with law enforcement agencies to support enforcement of underage drinking laws Media Advocacy – using mass/social media to strategically advance public policy initiatives Education and Awareness – increasing awareness of the harms of excessive and underage alcohol use as well as promoting effective excessive and underage drinking prevention strategies in communities across the state

Please list two adult contacts who are willing to serve as a reference for this application process.*

Please include name, relationship to student (teacher, guidance counselor, coach, mentor, etc.), phone, and email.

Skills Assessment: Please rate your experience on a scale from 1 (low level of experience) to 5 (high level of experience): *

Working as part of a team

Writing and editing materials in preparation to present information

Speaking in front of a group of people

Researching a subject and learning what the current science says about the issue

Offering my ideas and feedback in a group setting

Strategizing with others to look for the most creative and effective solutions

Being a leader on an issue I care about

Exhibiting courage in challenging situations

Working to help members of my team achieve a desired goal

Do you have any additional strengths that were not mentioned above? If yes, please share them here.*

ESSAY QUESTION: In no more than 500 words, please share what interests you most about serving on the Youth Leadership Council and how you believe your involvement would create positive change.*

If selected to participate in the Youth Leadership Council, I agree to commit to the following roles and responsibilities of the group:

*Hotel, mileage, and some meal expenses will be covered for scholarshiped participants

Leading by example through a commitment to being alcohol and other drug free Committing to at least one year as an active member of the Youth Leadership Council Participating in bi-weekly meetings in person or via Zoom and one annual in-person meeting in Omaha* Helping to create the agenda for the annual Youth Leadership Retreat Attending the annual Youth Leadership Retreat in Omaha in June 2023