Dane County Youth Governance Program
2016 Nomination Form
Name of Person Nominating:___________________________________________Email:__________________________________
Affiliation (i.e., school, church, organization, etc.) ______________________________________ Phone: _____________________
Potential YGP nominees are residents of Dane County who will be in grades 9-12 in Fall of 2016 who are consistently responsible,
dependable, and mature and who have leadership potential. They should also have the time capacity to commit to 2-3 meetings per
month for a total of 8-10 hours.
Youth First/Last Name
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Please return completed form by February 19, 2016, to:
Dane County Youth Governance Program
5201 Fen Oak Drive #138
Madison, WI 53718
Calkins.jessica@countyofdane.com
Or Fax to: Jess Guffey Calkins, (608) 224-3727
Thank you!
Street Address
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Current
Grade
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