Dartmouth-Cole Harbour Community Youth Council 2018-2019 - Application Form
Dartmouth-Cole Harbour's Constituency Youth Council is an opportunity to have your voice heard on policy and issues facing Canada.

To be considered for Dartmouth-Cole Harbour's 2018-2019 Constituency Youth Council, you must be aged 15-25 and be willing to commit to attending at least one meeting monthly and preparing for projects.

** Please complete and submit by October 15th, 2018 **

If you have any questions or concerns, do not hesitate to reach out to Megan Blumenthal at darren.fisher.a1@parl.gc.ca.

CYC
Full Name: *
Your answer
Birth date: *
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DD
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YYYY
Address: *
(*please include your postal code*)
Your answer
Phone number: *
Your answer
Email: *
Your answer
Are you a returning member of CYC? *
Do you identify as a member of an under-represented community? Please specify which community.
(*optional*)
Your answer
Level of Study (if you attend an educational institution) *
School Name *
Your answer
Grade/Year *
Your answer
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