New York State YMCA Youth & Government Officer Nomination Form
First Name *
Last Name *
Best Phone number to contact you *
Cell Phone
Email *
Current Grade in School: *
Number of years previously participated in Youth And Government: *
District *
I declare my candidacy for the position of: *
Previous Youth and Government experience and/or other qualifications: *
Why are you seeking this office and what do you feel you have to offer your peers if selected as one of their leaders for the coming year? *
Define servant leadership and describe how you plan to incorporate this if elected into office: *
Please upload a picture of yourself here. Your picture must be professional and appropriate. The candidate must be wearing professional attire and be the only person in the photo. The photo should not be edited or include text. *
Expectations of an Officer
I agree that if selected, I will adhere to all of the following standards:
Read, understand, and if elected to any position agree to:
1. Serve the conference I am elected to in its entirety to the best of my ability;
2. Be the best district member I can be through active participation in meetings, service projects, recruitment, and general support to my local officers and Advisor(s);
3. Assist my Advisor(s) and fellow delegates with the preparation, leadership, and on-site support throughout the year
4. Keep open and regular communications with YMCA staff by phone or email
5. Read all guidelines and officer packets sent to me by the Y-Staff
6. Attend ALL planned Leadership Training Conferences(September, December, and February; Dates TBD)
7. Contact assigned Y-Staff in writing at least 10 days prior to an event if you are unable to attend any of the workshops, training events, or conferences mentioned above with a reasonable explanation to the satisfaction of the YMCA Executive Director;
8. Abide by the rules and regulations of my school and the laws of my community, state, and country.

Furthermore, I understand that if I do not meet all of these requirements I may be removed from office at the discretion of the State Director. I also understand that my or my delegation’s failure to conduct my campaign in an appropriate manner will result in my being removed as a Candidate. My parents/Guardians have also read and agreed to these expectations. We agree to all of the above, and indicate this agreement by signing our names below.

Candidate Name *
Parent/Guardian Name *
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This form was created inside of Kentucky YMCA Youth Association. - Terms of Service