1110 Form 1 Application For Student Officers on the School Board

The Student members will be chosen by submitting an application by May 1 of each year. The board will decide who is the best fit to serve based on the candidate's capability to embody the voice and advocate for the interest of the students, dedication to enhancing education inclusive of a student view, and application.

Your Name:

Current Grade Level: —Please choose an option—10th Grade11th Grade

Home Address:

Phone Number:

GPA in the preceding school year:

Name(s) of Parents or Guardians:

Phone Number of Parents or Guardians:

School you Attend: Timpview HighProvo HighIndependence High

Extra-Curricular Activities (e.g. NHS, Student Council, Football):

Honors and Awards (e.g. Honor Roll):

I have carefully reviewed the eligibility requirements, guidelines and responsibilities, and expectations for serving as a Student Officer on the Board of Directors for the Provo City School District, and I attest that I am eligible and willing to meet all expectations.

By checking this box and typing my name below, I am electronically signing this form.

Signature of Student:
Signature of Parent:
Please attach the following along with your application:

1. A brief, written description of the applicant’s reasons for wishing to serve on the Provo City School District Board of Education

2. A current resume that includes honors and awards the student has received, extracurricular curricular activities the student has been
   involved in, and any other information the student believes is important to include

3. A personal narrative, not to exceed 1-2 pages, that includes the reason(s) the student would like to serve as the student representative to the School Board

4. Three letters of recommendation from adults familiar with the applicant’s qualifications, such as teachers, administrators, employers, and ecclesiastical leaders

5. A printed copy of the applicant’s attendance record for the past 12 months, obtained from the applicant’s school

6. OPTIONAL: signatures from 45 high school students currently enrolled in the Provo City School District

Sealed Transcript

A sealed, up-to-date transcript issued by the school registrar must also be submitted as part of the application. Please direct your sealed transcript by mail to the address provided below:

• Provo City School District

• c/o Assistant Superintendent of Secondary Education

• 280 W. 940 N.

• Provo, UT 84604

Please attach the following along with your application

I acknowledge I need to turn in my transcript

• Download 1110 Form 1 Application For Student Officers on the School Board