Boston Student Advisory Council Membership Form

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The Boston Student Advisory Council (BSAC), a citywide body of student leaders representing their respective high schools, serves as the voice of students to the Boston School Committee, offer perspectives on high school renewal efforts, and inform respective schools about relevant citywide school issues.

BSAC work on important issues and projects in committees includes but is not limited to: Student Rights, Student Voice in Decision Making, School Discipline, Safety and Equity, Environment Justice and writing for Teens in Print.

Membership Requirements - BSAC Members will:

Attend the 1st BSAC meeting of the School Year: Monday, September 30th from 4-6pm

Attend the All Member Training Monday, October 7th - Thursday, October 10th, 3:30-6:30pm

Represent their schools at BSAC Steering Committee Meetings every Monday, 4:00-6:00 PM, at the BPS Bolling, 2300 Washington Street, Roxbury, MA 02119

Keep their schools informed about relevant citywide school issues

Work on projects that BSAC develops during the year

Attend at least 1 School Committee meeting per school year

Perform scheduled assignments, ex: meetings with Headmaster and Student Government Advisor

Be responsive to all BSAC communication which includes email, text and calls

Part I. Student Applicant Information:

Name (First, Last)

Student ID #

School Attending

Phone Number

Home Address (# Street, City/Town, Zip Code)

Email Address

Age

Year of Graduation

Gender

Female

Male

gender non-binary/non-conforming

I prefer to self-identify

First Language:

Language spoken at home:

Race

American Indian or Alaska Native

Asian

Hawaiian or Other Pacific Islander

Black/African American

White

Hispanic

Other:

Part II. Emergency Contact Information:

Name

Relationship

Phone Number/Cell Phone Number

Do you have any allergies to medicine, food or other?

Yes

Clear selection

If you have allergies to medicine, food or other please list below:

Do you have a medical condition we should be aware of?

Yes

Clear selection

If you have a medical condition we should be aware of please list it below:

Do you currently take any type of medication?

Yes

Clear selection

If you currently take medication please list below:

Part III. Signatures:

By completing this form, you are providing your consent to the use of electronic signatures.

I hereby certify the following is true and correct:

My Parent/Guardian understands that as a member of BSAC I will need to attend BSAC Steering Committee Meetings every Monday, 4:00-6:00 PM

I understand the BSAC Membership Requirements; and, will attend the all Member Training and make the commitment to serve for one full academic year.

My school Headmaster understands the BSAC Membership Requirements

Signature

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