EPILEPSY FOUNDATION YOUTH COUNCIL APPLICATION

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1 EPILEPSY FOUNDATION YOUTH COUNCIL APPLICATION Dear Youth Council Applicant: Thank you for your interest in the Epilepsy Foundation s Youth Council! We are excited to potentially have you as a member! The Epilepsy Foundation Youth Council is: A great opportunity for YOU to make a difference in the lives of youth both with and without epilepsy A chance to learn more about epilepsy and what others are doing in your community and around the country to reach out to youth and adults about epilepsy A way to reach out in a leadership role to key political leaders about the importance of epilepsy and make positive changes for people with epilepsy through our government We are looking for youth, ages 18-22, who possess great leadership and teamwork skills, are motivated to make a difference in their communities, and can communicate messages effectively. Members of the Youth Council will be dedicated to developing and providing input on new programs, products, and events geared towards youth with epilepsy, their peers, and the community surrounding them. The Youth Council will meet twice a year, once in the Spring and once in the Fall. Notification of the dates and details are given months in advance to ensure attendance. All travel, hotel and meal expenses to attend meetings will be paid for by the Epilepsy Foundation. The Youth Council will also meet via conference call or online chat during the year. To apply for membership on the Epilepsy Foundation Youth Council, you will need to: 1. Be at least 18 years old, and under the age of Complete the attached application. Please use additional paper if needed for some of the longer questions. 3. Ask your local affiliate executive director to complete the affiliate recommendation form. 1

2 4. Sign the Statement of Commitment, and have your parent or guardian also sign it if you are currently under the age of Have Recommendation Forms completed by two non-family members (i.e. a teacher, employer, guidance counselor, etc). 6. Include an official copy of your most recent high school, college/university, or trade school transcript in your application. 7. Send everything to the national office address listed below If your application is selected as a finalist, you will have a phone interview scheduled with a member of the Youth Council Selection Committee. All applicants will be notified of the decision of the Youth Council Selection Committee. MAIL YOUR COMPLETED APPLICATION TO: Epilepsy Foundation Attn: Se an Bournes Program Coordinator 8301 Professional Place Landover, MD

3 Youth Council Membership Application I. About You Name: Date of Birth: Gender: M F Address: Home Phone Number: Alternate/Cell Phone: If applicant is currently under the age of 1 8: Parent/Guardian Name(s): Parent(s) address: City State Zip Home Phone Number: Alternate/Cell Phone: Parent/Guardian(s) Primary Language(s) Spoken at Home: Ethnicity (optional-for statistical purposes only): African American Caucasian American Indian Latino Asian Other II. School History List schools attended or attending (including high school, undergraduate, graduate, or any trade school or any other technical school), areas of study (as applicable), grade point average, and date (or anticipated date) of graduation: High School School Attended or Attending Areas of Study Grade Point Average Graduation Date or Anticipated Date College Other 3

4 III. About Your Experiences Please answer the following questions regarding the Epilepsy Foundation s Youth Council, using a separate sheet if necessary. 1. What is your experience with the Epilepsy Foundation (for example: working with your local affiliate, participating with the Public Policy Institute, etc)? 2. What talents or strengths would you bring to the Epilepsy Foundation Youth Council? 3. Describe your leadership skills and experiences in your community. IV. Essay On a separate sheet of paper, please tell us in a brief word essay why you want to join the Epilepsy Foundation s Youth Council. What do you want to accomplish as a member of the Council? How would you contribute most to the Foundation? PLEASE MAIL THE COMPLETED APPLICATION TO: Epilepsy Foundation Attn: Se an Bournes Program Coordinator 8301 Professional Place Landover, MD

5 Epilepsy Foundation Youth Council Statement of Commitment Name of Applicant If chosen as a Youth Council member, I understand it will be my role and responsibility to: Participate in leadership development training. Assist when available in Foundation affiliate activities within my area. Abide by the policies and standards established by the Epilepsy Foundation Board of Directors and the Epilepsy Foundation Youth Council. Participate in Youth Council conference calls or web activities/events Attend all semi-annual, in person, Youth Council meetings. Be a leader and positive role model at all Youth Council functions as well as in my school (if applicable), work, and community. As a Youth Council member, I will stay in contact with the Epilepsy Foundation national office and the Youth Council Chair. If I am selected, I understand that my travel, lodging expenses, and meals for Youth Council functions will be paid for by the Epilepsy Foundation. I understand that if I miss more than one meeting/conference call during my term of service, I will be asked to step down from the Youth Council. Signature Date Signature of parent/guardian if applicant is currently under the age of 18 Date 5

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