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2. South St. Paul Mayor's Youth Task Force
   We welcome your application to serve on the South St. Paul Mayor's Youth Task Force. Please complete the application form in full.
4. Personal Information
6. First Name*
7. Last Name*
9. Address1*
11. Address2
13. City*
14. State*
15. Zip*
17. Home Phone Number*
19. Cell Phone Number
21. Email Address
23. School Attending*
25. Legal Guardian's Name*
27. Legal Guardian's Phone Number*
29. Membership Interest
31. Why do you want to join the Mayor's Youth Task Force?*
33. When are you available to attend Youth Task Force meetings?*

    Check all that apply

    1. After School
    2. Evenings
    3. Saturday Mornings

    1. Saturday Afternoons
    2. Sunday Afternoons
35. If there is a time that you cannot attend, please note it here.
37. Discrimination Policy
    The City of South St. Paul does not discriminate on the basis of disability in the admission or access to, or treatment, or employment in, its services, programs, or activities. Upon request, accommodations will be provided to allow individuals with disabilities to participate in all City of South St. Paul services, programs, and activities. The City of South St. Paul does not discriminate on the basis of race, color, creed, religion, national origin, sex, sexual origin, disability, age, marital status, or status with regard to public assistance in employment or the provision of services.
39. Data Privacy Notice
    Our application requests that you furnish both public and private information about yourself. If applicable, your name, current employment position, previous work history, education and training are public data under the Minnesota Data Act (Minn. Stat. 13.43, subd. 2 & 3). It is available to anyone that requests this information. The data that you give us about yourself is needed to identify you and assist in determining your suitability for the Task Force for which your are applying. This data is not legally required, but refusal to supply the information requested may affect the City's ability to evaluate your application.
41. Electronic Signature
    By submitting this application electronically, you hereby state all information is correct and agree you have electronically signed this application.
Leave This Blank:


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

    This field is not part of the form submission.

45. Submit Submit and Print

* indicates a required field