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Youth Commission Member Application

  1. Youth App
  2. This application is for Roseville youths interested in volunteering with a City of Roseville Advisory Commission. In order to complete this application, you will need a valid email address. All items marked with a star (*) are required fields.
  3. Contact Information
  4. I am under age 18 *

    For youth applicants under age 18, please have a parent/guardian complete the Parent/Guardian Section below)

  5. City of Roseville Commissions

    The City of Roseville has citizen advisory commissions that allow Youth Commissioners. Each commission reviews specific areas of interest and provides advice to the city council.  Before filling out the application, please review the various commissions’ functions and duties. Each commission has their own webpage where you can learn more. 

  6. Note
    There is no character limit for the next two fields.
  7. Have you previously served on a board or commission for the City of Roseville?*
  8. Have you served on a board or commission for another governmental entity?*
  9. Voting (This section to be completed by applicant):

    Most commissions conduct a lot of their work by consensus as well as through dialogue and collaboration. However, there will be instances where votes are taken on items of interest. Youth Commissioners must choose whether they wish to be considered a voting member or a non-voting member of the commission when they apply. 

  10. I wish to serve as a voting member*
  11. If you choose to be a voting member there are responsibilities that you must acknowledge and agree to abide by. They include the following:*

    By checking each box you acknowledge and agree to abide by them. 

  12. Parent/Guardian

    Youth applicants less than 18 years of age are required to receive parental permission in order to serve on a City of Roseville commission. The following should be completed by a parent/legal guardian. 

    Please acknowledge by checking each box. 

  13. Parent/Guardian Acknowledgment - Application Data

    I understand that if the youth’s application is selected for consideration by the City Council, all of the data contained in their application materials and provided to the City in support of their application will be published in the City Council packet and will be made available to the public, with the exception of address, email address, and phone number. I give permission for this disclosure.

  14. Parent/Guardian Permission to Serve

    As parent/legal guardian, I give permission for the youth applicant to serve on a City of Roseville commission.

  15. Parent/Guardian Permission to Vote

    As parent/legal guardian, I give my permission for the youth applicant to serve as a voting member of a City of Roseville Commission.

  16. Parental/Guardian Image Permission

    As parent/legal guardian, I give my permission for the youth applicant’s image to be used and disclosed to the public in photographs, videos, websites and/or social media.

  17. Demographics

    The City of Roseville seeks to increase diversity on volunteer commissions; diversity in terms of: racial, economic, age, gender, geographic, sexual orientation, ownership, disability and education attainment. Your answers on this form help us determine the success of our efforts and are not used in determining appointments to boards and commissions. Your information is kept strictly confidential and when reported, will not identify any individual.

  18. If yes, into which category does your disability fall? (Choose all that apply)*
  19. What is your race/ethnicity? (Check all that apply)*
  20. Please type your name (this will serve as your digital signature)

  21. Please provide the best method to contact you, the parent/guardian, should the need arise. (Email, phone)

  22. Please type your name (this will serve as your digital signature). By typing my name, I agree that I wish to be considered for appointment to a City Commission.
  23. Leave This Blank:

  24. This field is not part of the form submission.