Form Center • 2025-2026 MYAC Application Form

Steps

1. MAYOR’S YOUTH ADVISORY COUNCIL MEMBER APPLICATION(current) This section is complete This section is incomplete
2. CIty of New Haven Mayor's Youth Advisory Council Permission Slip This section is complete This section is incomplete
3. Parent/Guardian Recommendation Form This section is complete This section is incomplete

CIty of New Haven Mayor's Youth Advisory Council Permission Slip

I give permission for (list the name of applicant below) to seek a position as a member and representative of the Mayor’s Youth Advisory Council.
Signature of Parent/Legal Guardian
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature
Permission for Photography
I certify that I am the parent, or a legal guardian of the minor listed below.
In consideration of my child seeking a position as a member and representative of the Mayor’s Youth Advisory Council, I grant to the City of New Haven, Indiana ("City”) the absolute and irrevocable right and unrestricted permission concerning any photographs of the minor which may be taken by the City or a subcontractor to the City or in which the minor may be included with others, to use, reuse, publish, and republish the photographs in whole or in part, individually or in connection with other material, in any and all media now or hereafter known, including the internet, and for any purpose whatsoever, specifically including illustration, promotion, and advertising, without restriction as to alteration; and to use the name of the minor in connection with the photographs if it so chooses. I release and discharge the City from any and all claims and demands that may arise out of or in connection with the use of the photographs, including without limitation any and all claims for libel or violation of any right of publicity or privacy. This authorization and release shall also inure to the benefit of the heirs, legal representatives, licensees, and assigns of the City, as well as the person(s) for which it took the photographs. I am a legally competent adult and am the parent or legal guardian of the minor listed below. I have read this document and fully understand its contents. This release shall be binding upon me and my heirs, legal representatives, and assigns.
Name of Minor
Name of Parent or Legal Guardian
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature of Parent/Legal Guardian
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Parent/Guardian Recommendation Form

(Form must be completed by applicant’s parent or guardian and returned with the Application)
Applicant's Name
Parent/guardian Name
Relationship to Applicant
Address
City
State
Zip Code
Phone Number
Alternate Phone Number
Email Address
(IMPORTANT: Please review all Mayor’s Youth Advisory Council application information and objectives with the applicant.)
Are you and your family willing to support the applicant’s involvement in the Mayor’s Youth Advisory Council Program?
1. Yes
2. No
Why do you feel the applicant would be a good candidate for the MYAC Program?
Please describe the leadership potential and motivation you see in the applicant.
What level of commitment has the applicant demonstrated at home, school and in other organizations?
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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2025-2026 MYAC Application Form

Steps

MAYOR’S YOUTH ADVISORY COUNCIL MEMBER APPLICATION

CIty of New Haven Mayor's Youth Advisory Council Permission Slip

Parent/Guardian Recommendation Form

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