Youth Leadership Council Application

If you have questions, please contact Project Extra Mile by calling 402-963-9047 or email us at info@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

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