Student Advisory Committee Application

Constituent Services / For Students /

Note: Fields marked with an * are required.

Office of Congresswoman Shelley Moore Capito

APPLICATION FOR THE 2010-2011 STUDENT ADVISORY COMMITTEE

1. Only completed applications will be considered.

2. Applicants must be enrolled in high school and reside in the Second Congressional District.

Applicant's Name *

Current grade level *

Home address *

Home phone number *

Cell phone

Age *

DOB *

What school do you attend? *

Cumulative grade point average *

List all clubs and activities *

What topics and/or speakers would most interest you? *

Essays (please limit to 250 words)

Please tell us what you hope to achieve as a member of the Student Advisory Committee. (Please include a brief description of your interests and activities and how you would contribute to the Committee) *

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Charleston, WV 25304
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Phone: 202.225.2711
Fax: 202.225.7856

Shelley Moore Capito - Congresswoman

Student Advisory Committee Application

Student Advisory Committee Application