Form FEMA Form 008-0-0- FEMA Form 008-0-0- FEMA Youth Preparedness Council Application Form

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency

OMB Control Number: 1660-NEW
Expiration: MM DD, YYYY

YOUTH PREPAREDNESS COUNCIL
FEMA Youth Preparedness Council
Application Form

PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this data collection is estimated to average 1 hour and 25 minutes per response. The burden estimate includes the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting
this form. This collection of information is voluntary. You are not required to respond to this collection of information unless a valid OMB
control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the
burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street,
S.W., Washington, DC 20472-3100, Paperwork Reduction Project (1660-NEW) NOTE: Do not send your completed form to this address.
Privacy Act Statement
Pursuant to 5 U.S.C. § 552a(e)(3), this Privacy Act Statement serves to inform you of why DHS is requesting the information on this form.
AUTHORITY: FEMA is authorized to collect the information requested on this form pursuant to 6 U.S.C. § 742, “National Preparedness”, and
Presidential Policy Directive - 8 (PPD-8).
PURPOSE: FEMA is requesting this information as part of the Youth Preparedness Council (YPC) application process. FEMA will use this
information to support the selection decision of the YPC members and provide acceptance/denial responses to applicants.
ROUTINE USES: FEMA will not routinely share this information externally. However, there may be specific circumstances which may warrant
sharing of information outside of FEMA, as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act of 1974, as amended. This
includes sharing this information as necessary and authorized by routine uses published in DHS/ALL-003 Department of Homeland Security
General Training Records, 73 FR 71656 (November 25, 2008) and DHS/FEMA-006 Citizen Corps Program, 78 FR 43890 (July 22, 2013) and
upon written request, by agreement, or as required by law.
CONSEQUENCES OF FAILURE TO PROVIDE INFORMATION: Furnishing this information is voluntary; however, failure to provide this
information may prevent selection from YPC membership.

DRAFT

Your information is being collected solely for use by FEMA with regards to the Youth Preparedness Council open applications. Your
information will not be shared with or used by any external entity unless prior permission is given.

APPLICANT INFORMATION
PERSONAL INFORMATION
Name
Age

Date Birth

Current Grade in School

Street Address
Zip/Postal
Code

State AL

City

Phone Number

Email Address
Gender/Sex
Parent's/Guardian's Name and Phone
Number

Race or Ethnicity (select all that apply)

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

White

Other/choose not to report
Have you previously applied to the Youth
Preparedness Council? If yes, what year did
you apply?

Yes

No

Yes

No

How did you hear about the Council?

Would you like to receive information from
FEMA about other preparedness
opportunities?
FEMA Form 008-0-0-24 (9/16)

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency
YOUTH PREPAREDNESS COUNCIL Continued
TWO (2) LETTERS OF RECOMMENDATION
You must attach two (2) letters of recommendation as part of a complete, eligible application. At least one (1) letter of
recommendation must be from an adult who can speak to your experience with preparedness and/or disaster(s). The second letter
of recommendation should be from an adult who is familiar with your involvement in the community. Examples of adults who may
write letters of recommendation include group leaders, teachers, advisors/counselors, school administrators, coaches, employers,
community or faith leaders, local first responders, or Citizen Corps Council or CERT Program members. You may not submit letters
written by family members, relatives, guardians, etc.
LETTERS OF RECOMMENDATION
Written By (Last name, First name)
Relationship to applicant
Written By (Last name, First name)
Relationship to applicant

ACADEMIC STANDING

DRAFT

Being a Youth Preparedness Council member is a rewarding and exciting experience, but it is also time-intensive. It is important that Council
members use time management skills to balance school, extracurricular activities, and their involvement in the Council. Please submit
academic records (e.g., report cards, transcripts) that demonstrate your good academic standing for the current and last school years.

FEMA Form 008-0-0-24 (9/16)

1

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency
YOUTH PREPAREDNESS COUNCIL Continued
Extracurricular Activities and Trainings
Please list extracurricular activities, extra academic activities, or volunteer activities (including position[s] held, if applicable) that you have
participated in.

DRAFT
Please list training(s) you have completed that are applicable to emergency preparedness.

FEMA Form 008-0-0-24 (9/16)

2

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency
YOUTH PREPAREDNESS COUNCIL Continued
NARRATIVE RESPONSES

Please respond to the following questions/topics in EITHER written OR video form. If responding in writing, complete the fields below, noting
the character limit for each response. If responding via video, please be sure to address all five (5) questions/topics in your video. Please keep
your video under 20 minutes in length. You may include the video file as an attachment to your application email OR you may upload your
video to a video-sharing website (e.g., YouTube) and provide the link in the box below.
Video Link:
1.

Why are you a good candidate to join the Youth Preparedness Council? Please include specific examples of how your past
leadership experience, previous emergency or preparedness training, and/or connections to the community would impact and
contribute to the Council. (Max 700 characters) Please attached supplemental information.

DRAFT

2.

What, if any, initiatives, activities, or events have you started or led in your school or community? (Max 700 characters)

3.

What skills would you bring to the Council? Please provide examples of how you have used these skills in the past. (Max 700
characters)

FEMA Form 008-0-0-24 (9/16)

3

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency
YOUTH PREPAREDNESS COUNCIL Continued

4.

What skills do you hope to develop while on the Council? (Max 700 characters)

5.

Please describe up to three (3) examples of your preparedness-related and/or disaster-related experiences. Preparedness-related
experience may include participation in preparedness activities and ways you have prepared yourself, your family, and your
community for future disasters. Disaster-related experience may include actions taken to respond or recover and lessons learned for
future disasters. (Max 700 characters each) Attach supplemental information as needed.

6.

Please describe any volunteer or extracurricular activities/projects you currently participate in that you would use as a platform to
promote disaster preparedness. Examples may include incorporating preparedness education into school sports teams, Scout
groups, etc. (Max 700 characters)

DRAFT

FEMA Form 008-0-0-24 (9/16)

4

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency
YOUTH PREPAREDNESS COUNCIL Continued
7.

Please describe any experience you have in public speaking, outreach, and publishing and how you would use this experience to
promote preparedness while serving on the Council. (Max 700 characters)

8.

Each Council member is required to complete at least one (1) self-selected local youth preparedness project during his or her first
year, and one (1) nationally focused group project during his or her second year.

DRAFT

Part A: Please propose a local or regional project that you might complete independently as a member of the Youth Preparedness Council.
Please note that if you are selected for the Council, you will have the opportunity to revise your proposed project, if desired. (Max 700
characters)

Part B: Please propose a national project that you might complete with fellow Council members during your second year on the Youth
Preparedness Council. (Max 700 characters)

FEMA Form 008-0-0-24 (9/16)

5

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency
YOUTH PREPAREDNESS COUNCIL Continued
SUPPLEMENTAL MATERIALS
Supplemental materials are welcome but not required. Possible supplemental materials include news about a preparedness or disaster
response activity in which you participated, preparedness materials that you developed, or pictures and video of a preparedness activity in
which you participated. Videos uploaded to video-sharing websites (e.g., YouTube) may be included by providing direct links. Below, please
identify any other files or links that you are submitting with your Youth Preparedness Council application. Please provide a brief description of
each file or link.
File Name 1:
Description:

File Name 2:
Description:

DRAFT

File Name 3:
Description:

SUBMITTING YOUR APPLICATION
The complete application - one (1) application form, one (1) video response (if applicable), two (2) letters of recommendation, academic
records (current and last school years), and any optional supplemental materials - should be sent in one (1) email to:
[email protected] .

FEMA Form 008-0-0-24 (9/16)

6