State Superintendent of Public Instruction /
Oregon Department of Education
Public Service Building, 255 Capitol Street NE, Salem, Oregon 97310
Phone (503) 947-5677 • Fax (503) 378-5156 • www.ode.state.or.us
Superintendent’s Youth Advisory Team Application
During Susan Castillo’s first campaign for Superintendent of Public Instruction, the idea of a student advisory board for the Oregon Department of Education was put forward by several of her volunteers. Susan embraced the idea of giving students an opportunity to voice their concerns about Oregon’s educational future. To this end, we created a Youth Advisory Team for Superintendent Susan Castillo; this group of Oregon public school students plays a role in changing and improving public education in Oregon.
We are in the process of recruiting 5-8 new members for the 2010-11 year. We are looking for a diverse group of high school students from all areas of the state who are ready to take on the challenge of advising the Superintendent of Public Instruction. Members must attend three to four meetings in Salem during the school year and should have an interest in using their personal experiences to advise the Superintendent and other state leaders, students, educators, and community members.
Education professionals are encouraged to advise a student to apply to the Youth Advisory Team. Please feel free to reference our website http://www.ode.state.or.us/superintendent/yat/.
Name______
Address______
______
Phone ______
Male__ Female__
Email Address______
Year in School______
School Name______
On a separate piece of paper, please include the following in one page:
§ Why you want to be on the Youth Advisory Team.
§ Three assets you will bring to the team.
§ A brief explanation of your involvement in public school (both curricular and extracurricular activities).
§ An accurate idea of your ability to attend the meetings held in Salem, given that the department cannot provide transportation.
Tentative meeting dates for the 2010-2011 year are:
- Oct. 1, 2010
- Jan. 28, 2011
- April 22, 2011
Members are required to attend all meetings. Applications are due by May 20, 2010. All meetings will be held at the Department of Education in Salem and will last from 10:00 a.m.–3:00 p.m. Please remember that a reference is required for each applicant (parents and relatives will not be considered references). All members must have access to a computer as all correspondence with the team about meeting logistics, agendas, and handouts will be sent by email.
I hereby state that the previously stated terms are true and I understand and am willing to accept them, knowing that if chosen to be on the Youth Advisory Team I will be responsible for following them.
Name______Date______
Signature______
Parent or Guardian Signature ______
Principal Signature ______
Send applications to:
Superintendent’s Youth Advisory Team
Oregon Department of Education
Attn: Diane Roth
255 Capitol St NE
Salem, OR 97310
Questions? Contact Diane Roth at the Oregon Department of Education: (503) 947-5791 Applicants will be notified of their selection by June 4, 2010.
Notice of Nondiscrimination
It is the policy of the State Board of Education and a priority of the Oregon Department of Education that there will be no discrimination or harassment on the grounds of race, color, sex, marital status, religion, national origin, age, or disability in any educational programs, activities, or employment. Persons having questions about equal opportunity and nondiscrimination should contact the Office of the State Superintendent of Public Instruction at the Oregon Department of Education.
REFERENCE
Name of Applicant: ______
Name of Reference: ______Relationship to Applicant: ______
Please give a brief description of why this person would be a quality candidate for the Youth Advisory Team based on your experience with them.
Name: ______Title: ______
Daytime Telephone Number: ______Email: ______
Mailing Address: ______
Signature: ______Date: ______
NOTE: THIS APPLICATION IS CONFIDENTIAL. DO NOT RETURN THIS RECOMMENDATION TO STUDENT. PLEASE MAIL DIRECTLY TO:
Superintendent’s Youth Advisory Team
Oregon Department of Education
Attn: Diane Roth
255 Capitol St NE
Salem, OR 97310
Questions? Contact Diane Roth at the Oregon Department of Education: (503) 947-5791.
All references must be received by May 20, 2010.