Kansas Youth Empowerment Academy (KYEA)

Board Application 


Date: _______________________     


c Youth (under 30 years of age)     c Non-Youth 


Name: ______________________________  


E-mail: ______________________________ 


Address: _______________________________________________________ 


c Day Phone: _________________  c Evening Phone: __________________

(Please check the phone number at which you prefer to be contacted) 


The KYEA bylaws require all youth members and 51 percent of non-youth members to be people with disabilities. 

Do you have a disability?   c Yes   c No 



Your Availability to Serve 


The KYEA board holds regular meetings each year. Are you able to attend regular board meetings?  

c Yes   c No 


What accommodations, if any, do you need to participate? ________________ 

____________________________________________________________ 



Your Background 


Please describe your previous leadership, community and advocacy activities?                      











What is your experience with high school students and young adults with disabilities and how did that affect you?       







Your Knowledge and Views of KYEA  


Why do you want to be a KYEA board member?         







Please write a brief statement of your understanding of what KYEA does.           







References (Please list name, address and phone number for each.)

1.


2.


3.


Signature