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Superintendent’s Student Advisory Board APPLICATION

4400 Livernois, Troy, MI 48098 - (P: 248.823.4003), (F: 248.823.4012) - Richard M. Machesky, Ed.D. - Superintendent of Schools - rmachesky@troy.k12.mi.us

Candidate's First Namerequired

Last Namerequired

Graderequired

Home Street Addressrequired

Student Email Addressrequired

Cell Phone #

Home Phone # (if applicable)

List one Academic Honor and one Extra-Curricular Activity; Include other Awards

Attach awards (Optional)

Max file size: 10 MB

List Leadership, Community, or Volunteer Service and Achievements

What are you curious to learn about in the future?

Tell about a time in your life where you have shown grit, determination, or persistence

What are you currently the most optimistic about? Pessimistic?

List 2 or 3 observations, thoughts, or ideas you have about the Troy School District?

What do you hope to achieve, personally, as a member of the Superintendent's Studnet Advisory Board?

Additional Comments

I agree to the Electronic Signature

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ACCEPTANCE and SIGNATURE

I, the Student, understand by checking this box and typing my name, I have read this form and agree that this will serve as my electronic signature.

Attach current year Report Card

Max file size: 10 MB

Attach Reference Letter(s)

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