TNB Member Application 2017-18
ELIGIBILITY:
Student at any Arlington County High School (public or private) 14-18 years old

DESCRIPTION:
The Teen Network Board (TNB) is a group of high school students who strive to:
• Strengthen teen voice in the community
• Provide a teen perspective on school and community issues
• Make a positive difference in Arlington

Teens meet in groups that address specific issues such as drugs and alcohol, positive peer relations, teen employment/volunteer/community service options for teens. They develop strategies on how to make changes in their community and implement the strategies through meetings, planning sessions, and presentations to the County Board and middle school youth; this includes other county government agencies and community groups.

MEMBERSHIP:
Appointed Members: Appointed members of the Teen Network Board are limited to *24* teens. Appointed members must have been on the TNB one year. They have the opportunity to be elected into leadership positions by their peers to serve one year as co-chairs of the TNB or to serve as subcommittee chairs for one year. Appointed members have the right to vote on items brought forth by committees and the leadership. All appointed members MUST attend 15 out of 18 scheduled meetings. They are encouraged to attend all meetings.

General Members: General members of the Teen Network Board are not limited by number. They are allowed to participate in all general meetings and encouraged to join a subcommittee. They will work with all the members on projects and recommendations that the TNB undertakes. There is no attendance requirement for general members but are invited and strongly encouraged to attend all meetings.

Contact: Siobhan Grayson, MSW
Youth Coordinator - Arlington Partnership for Children, Youth, and Families
2100 Washington Blvd. Suite 300 Arlington, VA 22204
Direct Line: 703-228-1506 Fax: 703-228-1169 sgrays@arlingtonva.us

Personal Contact Information
Full Name
Ex. Jane Smith
Your answer
Date of Birth
MM
/
DD
/
YYYY
Address
Your answer
City
Your answer
State
Enter abbreviation (ex. VA)
Your answer
Zip code
Your answer
Phone (cell)
Please put number in this format: xxx-xxx-xxxx
Your answer
Phone (home/other)
Please put number in this format: xxx-xxx-xxxx
Your answer
Email
Your answer
Best way to contact me is through:
(Check all that apply)
Required
Parent/Guardian Contact Information
Parent/Guardian full name
Your answer
Relation to applicant
ex. Mother
Your answer
Parent/Guardian phone:
(Submit the best number to call if there is an emergency. Please put number in this format: xxx-xxx-xxxx)
Your answer
Parent/Guardian email
Your answer
School Information
High school for 2017-18 Academic year
Select the grade that you will be in next year
Activities
List clubs or activities that you have or plan to participate in
Include the year and leadership roles if applicable.
Your answer
Teen Network Board Participation
Teen Network Board Involvement Preference
Find descriptions of the two roles at the top of this form.
What forms of TNB involvement would interest you?
Check all that apply. Co-Chair positions and Committee Chair positions are only for returning members.
This Year
In Future Years
Not for me
Participate in meetings
Attend Special Events
Assist in planning of special events
Promote TNB through Facebook/social media
Be photographed for publications
Attend Conferences
Participate in Focus Groups
Serve as the Co-Chair of TNB (Returning, Appointed Members only)
Serve as a Committee Chair (Returning, Appointed Members only)
Short Answer Questions
1. Why do you want to be a member of the Teen Network Board?
Your answer
2. What skills will you be able to bring to the Teen Network Board?
Your answer
3. How did you hear about the Teen Network Board?
School announcement, personal recommendation, arlingtonteens.com, etc.
Your answer
Adult References
Please list two non-family member adult references who can speak about your desire to make an impact in the community or about special that skills you possess.
1. Adult reference full name
Your answer
1. Adult reference phone
Please put number in this format: xxx-xxx-xxxx
Your answer
1. Adult reference email
Your answer
2. Adult reference full name
Your answer
2. Adult reference phone
Please put number in this format: xxx-xxx-xxxx
Your answer
2. Adult reference email
Your answer
Confirmation of Authenticity
I certify that the statements made on this application and all supporting materials are true and accurate. I have also read and understand the time commitments and responsibilities of the position outlined in the descriptions.
By checking the box below, I agree to the Confirmation of Authenticity outlined above.
Required
Parental/Guardian Consent
I give my child permission to participate as a member of the Arlington Teen Network Board. I release the Partnership for Children, Youth, and Families, individual volunteers and staff, and Arlington County Government from all liability relating to Teen Network Board activities.
By checking the box below, I agree to the Parental/Guardian Consent outlined above.
Required
Photo Release
Parental/Guardian Transportation Consent
The Teen Network Board hosts and attends events outside of its biweekly meetings. These include but are not limited to regularly scheduled meetings, trainings, conferences, panel discussions and other identified activities included in the membership/participation of TNB. Events may be located in bordering states or counties.
Emergency Contact
In the event of an emergency, contact...
Emergency contact full name
Your answer
Emergency contact phone (daytime)
Put number in this format: xxx-xxx-xxxx
Your answer
Emergency contact phone (evening)
Put number in this format: xxx-xxx-xxxx
Your answer
Emergency contact relation to applicant
Ex. Neighbor or Parent
Your answer
Statement of Commitment (Required for Appointed Members)
The Teen Network Board will provide the following to its members throughout their term:
• Respect for your opinions
• Engage you in meaningful activities that allow you to develop and learn new skills
• Relay important information to you in a timely manner
• Meetings will follow the school schedule and dates will be made available at the beginning of the year.

The TNB Youth Member agrees to complete the following throughout his/her term:
• Participate in at least 15 out of 18 meetings
• Attend meetings regularly and provide suggestions, ideas, and opinions to the team
• Serve on one of the committees
• Check and respond to email regularly and promptly
• Work to promote the mission of the TNB to others in the community
• Help the team to define, monitor, and reflect on the implementation of our mission statement

The TNB understands that scheduling conflicts with meetings and/or special events may occur throughout the TNB Youth Member’s term. When necessary, the youth will inform the team of his/her scheduling conflicts by notifying the Co-Chairs ahead of time.

By checking the box below, I certify that I have read and agree to the Statement of Commitment outlined above.
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