Youth Advisory Board - Nomination Form
Media Power Youth is an educational nonprofit whose mission is to inspire young people to engage with media in thoughtful and constructive ways that support their physical and mental well-being. We are opening applications for new students to join our youth advisory board, which guides us in developing student-centered curricula and programs. We are seeking teens who want to share their opinions on media and ways to support youth in navigating the challenges of digital technology. Students entering grades 9 through 12 in the fall of 2022 are invited to apply through an online application. Meetings will take place on Zoom on the 2nd Monday of every month from May 9, 2022 to May 8, 2023.

We require that a teacher/counselor/administrator nominate a student for this program. To nominate a student for the Youth Advisory Board, please fill out the information below. We ask that you also provide your contact information so we can reach out to you with any follow-up questions.

All applications and nominating forms must be completed by Tuesday, April 26th. Forms and information can be found online at mediapoweryouth.org/youthmediasquad.

We are also currently seeking elementary and middle school educators to join our educator advisory boards! If you or an educator you know is interested, please visit mediapoweryouth.org/educator-advisory-board to learn more and apply. For more information about Media Power Youth, visit mediapoweryouth.org.
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Student First Name *
Student Last Name *
Nominator First Name *
Nominator Last Name *
Nominator Email *
Phone *
School of Student *
State where school is located *
City/Town where school is located *
Your role *
If you are a teacher, what subject do you teach? *
What grade do you teach? *
Relationship to Student *
Why do you nominate this student for this program? *
Please provide three adjectives that best describe the student: *
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