Volunteer Staff Application Form

Return completed applications to:

Missouri Youth Leadership Forum
301 West High Street, Room 840
PO Box 1668
Jefferson City, MO 65102

OR

By email: rachel.rackers@oa.mo.gov

OR

By fax: 573-526-4109


For additional Information
Contact Rachel Rackers	
573-526-4564
rachel.rackers@oa.mo.gov


 
2020 REGIONAL LEADERSHIP FORM VOLUNTEER STAFF APPLICATION

**All locations are postponed until spring 2021**

Applications have to be submitted or postmarked by January 31, 2021


Which Regional Leadership Forum would you like to attend? (Choose ONE)

Jefferson City on March 13th  
	
Cape Girardeau on March 20th

Kansas City on April 10th  

Springfield on April 17th  



Name:______________________________      Date : _____________________

Mailing Address: ________________________________________________

City________________________ State____________ Zip Code_____________

Telephone: _____________________________  E-mail: _______________________   

T-Shirt Size: _________________________  

======================================================================================================

Applicant Status: Check ALL that apply:

____  New Staff Applicant

____  YLF Alumni, if checked, year you attended YLF  _________

____  Former YLF staff member, year(s) on staff  _______, _______, _______, _______.


Please list any accessibility or accommodations needed 

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Person to notify in case of an emergency (please provide two names):
Name: ___________________________________________ Relationship:________________________

Address:___________________________________________________________________________________
								City			State		Zip Code

Telephone Number:(____)__________________________Cell Phone: (_____)__________________________
		      Area Code					              Area Code


Name: ___________________________________________ Relationship:________________________

Address:___________________________________________________________________________________
								City			State		Zip Code

Telephone Number: (____)__________________________Cell Phone: (_____)__________________________
		      Area Code					               Area Code



Please list any allergies that you have (food, medication, animals, etc.): _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Do you have any special dietary needs?        Yes       No   If yes, please specify:
_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please share any additional medical information that you feel would be beneficial to a doctor in case of an emergency. _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


REFERENCES (please list three, include telephone number)

1.________________________________________ Telephone: _______________________________________

2.________________________________________ Telephone: _______________________________________

3.________________________________________ Telephone: _______________________________________