HAZLETON CITY COUNCIL

JUNIOR COUNCIL ADVISORY MEMBER APPLICATION

NAME:                                                                                                          

ADDRESS:                                                                                                    

PHONE:                                          E-MAIL:                                                  

AGE:                                               DATE OF BIRTH:                                      

GRADE (2017-2018 School Year):                                                                 

SCHOOL:                                                                                                      

I would like to be considered for the position of a Hazleton City Council Junior Council Advisory Member because (Please state in 200 words or less. Use the back of this form or attach another sheet, if necessary):

                                                                                                                    

                                                                                                                    

                                                                                                                    

                                                                                                                    

                                                                                                                    

                                                                                                                    

                                                                                                                    

                                                                                                                    

                                                                                                                    

                                                                                                                    

                                                                                                                    

                                                                                                                    

                                                                                                                    

Please return this completed form by email, U.S. mail, or fax to:

Eileen Matenkoski, City Clerk

CITY OF HAZLETON

40 North Church Street, 2nd Floor

Hazleton, PA 18201

459-4986 (Office)

459-4969 (Fax)

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