Form

Today's Date
- Month - Day Year
at
/ Hour Minutes
JUST THE FACTS
First Name:*
Last Name:*
Phone:
E-mail:*
School Attending
Current Grade
Your Birthday
Month Day Year
AVAILABILITY
Available during the

Morning Afternoon Evening Anytime
I can help on

Weekdays Weekends Anytime
MEMBER SPOTLIGHT INTERVIEW
We would like to feature you on our website. Please take a minute to fill out the following questions. We will post your details within the week.
Current Photo of you
Click icon to e-mail your photo if you are having trouble sending it.
SOCIAL NETWORKING
Can we share this?*

Yes No
FaceBook
MySpace
Flickr
DeviantArt
Other
INTERVIEW QUESTIONS
(If any of these questions does not apply, please put n/a)
What issues do you feel are important for teens today to be aware of?
1.*
What are your interests and hobbies? What about special skills (i.e. I am an artist, I speak 2 languages, I build web banners etc...)
2.
What group(s) have you volunteered with? What did you enjoy most about your experience?
3.*
Are there any clubs or leadership boards you are involved with in school?
4.*
A national book company is interested in your life story. How would you describe your "biography" (i.e. Was born in IL, have 4 brothers, etc...)
5.*
You are playing the "Getting to Know You" Game with your friends. The current card states: "Sum up your friend in 4 words" What words do you think they would use?
6.*
Now turn it around and tell us what 4 words you would use to describe yourself:
7.*
Should be Empty:

JUST THE FACTS