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KYC Form Folder

Used for KYC Form Development

Kansas Advisory Group
Youth Committee
Membership Application and Participation Agreement
Date of Birth   Applicant's Date of Birth
/ /  
Are you under age 18?  

If you are under age 18, Parent/Guardian information must be provided.
Are you currently going to school?  

If you are attending school:
REFERENCE (Someone over the age of 18 years)
Read the Youth Committee Participation Agreement
Acknowledgement of Participation Agreement  

Youth Committee
Participation Agreement

I understand I am applying to become a member of the Youth Committee of the Kansas
Advisory Group.  I understand if I am selected, I may serve the Youth Committee until
my 21st birthday and continue as an alumni member with the permission of the Chair.

If chosen as a Youth Committee member, I understand it will be my role and

responsibility to:

Actively participate in Youth Committee meetings;

Be involved in planning and attending meetings and events of the Committee;
Be willing to listen to concerns and ideas of other youth in care and provide

recommendations to the Youth Committee as a voice for youth in Kansas;
Respect other's opinions and be responsible for expressing my own;
Be willing to do my part;

To exercise good judgment:

Follow the guidelines and policies of all meetings and events;

Be a leader and positive role-model at all meetings and events.

As a Youth Committee member, I will stay in contact with the Chair and promptly report any
changes in my address, phone number, or email address.  I am committed to enhancing the
lives of Kansas youth through my advocacy efforts as a Youth Committee member.