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TCR School Based Wellness

Committee

Student Application
Please Return completed applications to: Xenna Smith (Senior) by: December 5th

1. Name: _________________________________________ Age: ________

2. What grade are you in? (Please circle one) Freshman Sophomore Junior Senior

3. Contact Information: (email and/or phone number):

_____________________________________________________________________________________________

4. Please describe some of your strengths.

5. What makes you interested in health issues relating to school(s)?

6. What are some past experiences that could help you be a member of this committee? (ex.
taking a foods class)

7. Can you be committed to attending meetings regularly, most likely during SMART period and
rarely after school? (Dedication to the committee is a key factor in the decision process) Yes
No

8. What does wellness mean to you?

9. Where do you see wellness issues in the school (food access, physical activity, mental health)?
10. What could you bring to the table at this wellness committee? (Personality, perspective, etc.)

11. Please add any comments, questions, or concerns.

Thank you for your application!

Turn this in as soon as completed to ensure your acceptance.