Chief's Youth Advisory Council Application

Please complete this application in its entirety. If you have any questions regarding how to complete the application, please contact Officer Dedra Worley at (719) 499-6787. Once your application is received, you will be contacted as to the outcome. Please note the selection process can take several weeks to complete.

Current Start
School Information
Essay Questions
Agreements
Complete

Full Name

Please enter your full first and last name.

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

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Home Phone

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Cell Phone

Name of Parent or Guardian

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Phone Number of Parent/Guardian

Your Date of Birth

Gender

Ethnicity (Optional)

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