Please complete and return ALL sections of the application to the Child and Youth Program Office. All applications are due by October 1, 2018.

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1 State Teen Panel (STP) Application Due to: Mark Lukasiewicz Office Phone: Fax: Child & Youth Program Coordinator Address: JFHQ A-1 RM NW 70th Avenue Johnston, IA Requirements for Eligibility Applicant must be between the ages of 13 and 17 as of September 1, Applicant must be a Military connected youth (a dependent, sibling, and/or stepchild) of an Army or Air Force National Guard Soldier). Applicant must be able to commit to the objective, key results, and schedule listed in the position overview document during the year (fall, spring, and summer). Please complete and return ALL sections of the application to the Child and Youth Program Office. All applications are due by October 1, SECTION I: Applicant Information Full Name: Preferred Name: Date of Birth: Age: Gender: M F T-Shirt Size: Youth L Youth XL Adult S Adult M Adult L Adult XL Mailing Address: Facebook ID: Cell Number: Address: SECTION II: Parent/Legal Guardian Information Name of Mother (or primary legal guarding): Occupation: Cell Phone: Work Phone: Address: Name of Father (or secondary legal guarding if applicable): Occupation: Cell Phone: Work Phone: Address: STP Application - 1 -

2 SECTION III: School Information Year in School (Fall 2018): 7 th 8 th 9 th 10 th 11 th 12 th Name of School: Address of School: School Office Phone: SECTION IV: STP Please complete the following six questions on a separate document and attach to the final application. Acceptance will be based on the quality of answers provided by the applicant and the applicant s eagerness in involvement with the State Teen Panel. 1) Tell us about your life experience as a military connected youth. 2) Give an example of someone you look up to as a leader and why they take that place in your life? 3) The Child & Youth Program is available to any teen with a family member in the Military throughout the entire state. If you could dream about the impact of this program, what comes to your mind? 4) As a member of the STP, you will serve as a role model for others in our state. What qualities do you believe a role model should possess and in what ways do you personally demonstrate some of those qualities? 5) There are many short speaking opportunities for STP members. What experience(s) do you have speaking in public? 6) How much experience have you had with time management? What are other extracurricular activities you will be involved in during the fall, spring, and summer months? How will you keep the STP a priority in a busy schedule? SECTION V: Letters of Recommendation Please submit both letters with your application. These letters should include an address and/or phone number for the person writing the letter. 2 Letters of Recommendation Required 1. One from a relative or family member. 2. One from a person not related to you. (Examples include but are not limited to a teacher, coach, or community leader such as a Boy/Girl Scouts Leader, 4-H Leader, Pastor, or other Youth Leader.) STP Application - 2 -

3 SECTION VI: Required Signatures Parent/Guardian Permission and Release I will support my child as he/she serves the Youth Program if they are selected as a delegate of the State Teen Panel. I am willing to allow my child to travel or provide transportation myself to help them fulfill all responsibilities of this position. In addition, I hold the Iowa Youth Program, its Contractors, the Services Branch Office, the National Guard Bureau, the National Guard Child and Youth Program, program volunteers and the harmless from injury or death that occur as a result of participation. Parent/Guardian Signature Date Youth Participant Pledge As a military connected youth myself, I believe in the importance and impact of the Child and Youth Program and pledge to support and serve its core values with my best efforts through the State Teen Panel. I pledge to assist the Child & Youth Program Coordinators with the mission and vision of the Youth Program, to own the objective of the Teen Panel, to strengthen my personal leadership skills as an active member of the Teen Panel, and to be an advocate for all military connected youth in the state of Iowa. I am aware that, should I be selected as a delegate of the STP, it is my responsible to ensure that safe transportation is available for me to attend the required meetings (see Schedule section in Position Overview Document). I understand that failure to attend meetings may result in their dismissal from the STP. Youth Applicant Signature Date *Please Note Acceptance and service on the Iowa State Teen Panel is done strictly in a statutory volunteer status. There will be no payment for hours worked; however, associated travel costs will be reimbursed to the selected applicant and volunteer hours will be recorded for events attended as part of the STP. STP Application - 3 -

4 State Teen Panel (STP) Position Overview Child and Youth Program VISION & MISSION Vision: We exist to impact the culture of Military connected youth in Iowa so that they and their families thrive in the face of challenges. Mission: We provide a support system to Military youth and their families through programming events, teaching life skills, managing resources, and connecting to local communities. Child and Youth Program CORE VALUES We behave with the following three core values toward military families and the sacrifice they make for our nation. 1. You re not just guests you re family. Hospitality We make it as easy as possible for families to feel welcomed and connected to the National Guard Family. 2. We hear your cries and we want to help. Empathy We seek to understand and positively impact the very real challenges military connected youth face. 3. We understand that freedom comes with a price. Compassionate support and honor We are proud of all Military families and will always go the extra mile to serve them. ROLE OBJECTIVE The STP exists to help the LCYPC and CYPC fulfill the Child and Youth Program mission and vision by assisting in event planning and execution, strengthening their personal leadership skills, and ultimately being a voice for Iowa s Military connected youth. KEY RESULTS The STP position is held for one year. The member can then choose to reapply for additional years after. During the year they are expected to: Be an advocate for key challenges that Military connected youth currently face. Develop leadership, teamwork, and networking skills. Take part in selected events sponsored by the CYP. Participate in all meetings and retreats. Be eager to represent the STP and/or the CYP at community events if the opportunity arises. Be actively pursuing public service in and around your community.

5 SCHEDULE Fall Forum This event will be an overnight stay in November at a hotel in the Des Moines area. It will include training and activities to help STP members connect and plan for the year, resilience and life skill teaching and a service project. Spring Retreat This event will be a full weekend in February and will take place on Camp Dodge. It will include leadership workshops led by an internationally renowned trainer BJ Penick, Military-based team leadership training, Month of the Military child planning and preparation, and many opportunities to connect. Summer Regional Conference Every year the STPs from Region 7 (Iowa, Missouri, Kansas, and Illinois) gather for a four day conference in June. The location rotates between states. The goal of this event is to foster connection and ideas across the different state s teen panels. This is the number one event for the teen panels throughout the year. Program guidelines allow 10 members to participate when Iowa hosts the conference and 5 members to participate when it is out-of-state. Plan and participate in selected CYP events. Each semester (fall, spring, and summer) we will present 1-3 events that the STP will have opportunities to help plan and execute. We require participation in at least one of these events each semester and will work to keep the events within a 2 hour driving radius of the member s home location. Community Service Each STP member must record a total of 10 hours of community service between November 2018 and August A volunteer Record Sheet will be provided to record these voluntary contributions and will be collected at the end of August. ELEGIBILITY/REQUIREMENTS Must be between the ages of 13 and 17 as of September 1, Must be a Military connected youth (a dependent, sibling, and/or stepchild) of an Army or Air Force National Guard Soldier). Must be able to commit to the above objective, key results, and schedule during the year (fall, spring, and summer). Must complete the application in order to have an opportunity to be selected. Contact Mark Lukasiewicz, Child & Youth Program Coordinator, at mark.s.lukasiewicz.ctr@mail.mil for additional questions. You can find the link for the 2018 STP Application on the Youth Page at All applications are due October 1, 2018.

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