2. All applicants must reside in the City of Miramar, unless otherwise stated in the City Code, and may belong to only 1 Advisory Board at a time. Applications not submitted online must be typed or printed and completed in full.
   
   Advisory Board Applications will be kept on file for 1 year only. After its expiration, you will have to re-submit a new application.
4. Salutation
   -- Select One --Mr.Mrs.Ms.MissDr.Prof.
6. Name
8. Primary Phone
9. Secondary Phone
11. Address
13. City
14. State
15. Zip Code
17. Student Email
    Email addresses become a part of the Public Record on submittal of the form.
18. City Resident

    1. Yes
    2. No
20. 1. I've read About Teen Council Advisory Board. I understand that after 3 absences of meetings I may be removed from the board.
22. 1. I (Parent/Legal Guardian), authorize my son/daughter to attend meetings and participate in the activities of the Teen Council Advisory Board.
24. School
25. Grade
27. Parent/Guardian Email
28. Parent/Guardian Phone
30. My Committment of Participation
    The Teen Council Advisory Board meets the 1st Thursday of each month from 6 - 7:30 p.m.
32. Are you able to attend meetings on the mentioned days and times?

    1. Yes
    2. No
34. If no, please explain why:
    Your input is limited to 255 characters.
36. Qualifications/Educatonal Background
    Briefly describe your specific expertise and/or abilities relevant to your board choice in place of these directions. Your input is limited to 255 characters.
38. Community/Civic Organization You Are Affiliated With
    List the organization name, years of service (i.e. 2001-2002), and offices held (i.e. chair, member), in place of these directions. Your input is limited to 255 characters.
40. Acknowledgement
    I understand that in accordance with the Florida Sunshine Law, this information may be made public. If appointed, I agree to faithfully and fully perform the duties of my office and will comply with all laws and ordinances of the City, County, and State of Florida. Particularly those pertaining to the conduct of public officials and the financial disclosure requirements.
42. 1. Acknowledgement is required for board position by checking box.
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field