Advisory Council Application - Advisory Council

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Advisory Council Application

Please complete this form if you are interested in joining the Itasca Area Community Education Advisory Council.


First Name:	*

Last Name:	*

Phone:	*

Email:

Address:	*

Address:

City:	*

State:

Zip:

Age Group	*

Gender	*

What Community location are you affiliated with?	*

Which Community Education programs/events/projects are you most interested in? (Check all that Apply)
		Early Childhood Family Education
		Youth Enrichment/Development
		Adult Enrichment
		Children First!
		Family Support
		Senior Programming

Why do you wish to serve on the Community Education Advisory Council?	*

Send a copy of the completed form to this email address :

* Indicates Required fields.