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<br />PEA, <br />~ \~ - ~/ ^ <br />Youth Advisory Council of South Bend <br />Application Form <br />1. Complete this application (please print or type), sign, and mail or deliver to: <br />Office of the City Clerk <br />4th Floor County-City Bldg. <br />South Bend, IN 46601 <br />Or email completed application to: http://www. <br />2. Download the "Parent/ Legal Guardian Permission/ Release" form, have parent/ <br />guardian sign, and include with completed application. <br />3. Include two letters of recommendation from an unrelated adult who has known <br />you and has worked with you. <br />Date: <br />Name: <br />School: <br />Home Address: <br />City: <br />Zip: Telephone: <br />Email address (if applicable) <br />Date of Birth: <br />Grade: <br />Gender: M: F: <br />In which Council District do you live: <br />(If you are unsure of the district, call the City Clerk's Office at 235-9221) <br />