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2. The Board of Directors of the Lenawee Youth Center, Inc. is comprised of an all volunteer group of Lenawee County residents, members of Probate Court, members of the Lenawee County Board of Commissioners and the Director of the Campus. 

   The goal of the Board is to support the vision of the founders of LYC, Inc., Probate Judge Maurice Spear, Superintendent of Adrian Public Schools William Austin and county businessman Ray W. Herrick. 

   The role of the Board is to: 1) insure Board positions are filled with dedicated and qualified individuals, 2) act as a public relations body to generate positive awareness of the Campus, 3) raise funds to support campus programs and 4) manage, invest and disperse donations, endowments and trusts established by donors.

4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*

15. Please list two references:

17. Name*
19. Phone*
20. Email*
22. Name*
24. Phone*
25. Email*
27. Relevant experience and/or employment*
29. Please list boards and committees that you serve or have served on (e.g. Business, civic, community, fraternal, professional, recreational, social)*
31. What other volunteer commitments do you currently have? *
33. What experience do you have working with youth? *
35. Why are you interested in serving as a Board member of LYC, Inc.? *
37. Please choose area(s) of expertise/contribution you feel you can make to further the mission of LYC, Inc:*

    1. Youth outreach/advocacy
    2. Nonprofit experience
    3. Youth programs/events
    4. Finance/accounting

    1. Strategic planning
    2. Program evaluation
    3. Fundraising
    4. Social media / communications

    1. Graphic design / technology
    2. Public relations
    3. Grant writing
    4. Other
39. Other (if applicable)
41. How do you feel LYC Inc would benefit from your involvement on the Board?*
43. Are you aware of any information about yourself, which might tend to reflect unfavorably on your reputation, morals, character or ability as a board member of LYC?*
    -- Select One --YesNo

    If yes and would like to explain, please email rodney.weaver@lenawee.mi.us.

44. Have you ever been convicted of a felony?*
    -- Select One --YesNo

    If yes and would like to explain, please email rodney.weaver@lenawee.mi.us.

46. Have you ever been convicted of a controlled substance offense?*
    -- Select One --YesNo

    If yes and would like to explain, please email rodney.weaver@lenawee.mi.us.

47. Have you ever been convicted of a sex-related crime?*
    -- Select One --YesNo

    If yes and would like to explain, please email rodney.weaver@lenawee.mi.us.

49. I understand Board meetings are currently held the 1^st Wednesday of each month at 12:30 p.m. and concluding generally by 1:30 p.m. Board members have the option of eating lunch with MSC residents and staff at 11:45 a.m.  

    I understand all Board members shall serve on at least one committee.

    I attest that the information that I have provided is true and correct. Additionally, my signature represents my agreement to participate pursuant to the bylaws of the LYC Inc Board of Directors.

51. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
53. Electronic Signature
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

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