My Community Cooperative Youth Leaders Program Application "*" indicates required fields Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Student Phone Number*Date of Birth* MM slash DD slash YYYY Names of Parent(s) or Guardian(s)* Parent/Guardian Phone*Parent/Guardian Email* Name of School you Attend* GPA*Career Goal*School Activities*Please include years of participation, elected positions, special honors, awards and accomplishments. Extracurricular Activities*Community, church or any clubs outside of school. Please include years of participation, elected positions, special honors, awards and accomplishments. Why would you be a good representative for Coast Electric in the Youth Leadership Program?*T-shirt Size* Dietary Needs/RestrictionsDate Completed* MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged.
