Youth for Climate Action Working Group Application

Please fill out all the fields below.

Name:

Age:

Preferred pronoun (they/them, she/her, he/him, etc):

School:

Grade:

Phone number:

Email address:

Which organization is nominating you?

Who is the contact person with that organization?

What is the contact person's email address?

Please upload your teacher's written permission

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Are you passionate about climate change?

Yes

No

Are you concerned about extreme weather events and the future of our planet?

Yes

No

Are you a resident of Cornwall, Ontario?

Yes

No

Do you understand that this is a volunteer position and there is no payment for your involvement?

Yes

No

Meetings will be monthly, on a Monday from 2:30 p.m. to 4 p.m., in the City of Cornwall. Do you have permission from your teacher to miss class in order to attend these meetings?

Yes

No

If you are not initially selected for the Working Group, would you like to remain on a waiting list in case a space becomes available?

Yes

No

In less than 100 words, tell us why are you interested in being a member of Cornwall’s Youth for Climate Action Working Group.

What are you hoping to achieve and/or obtain as a members of the group?

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Youth for Climate Action Working Group Application