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Mecklenburg County Teen Tobacco Use Prevention & Cessation Advisory Board Recommendation

The purpose of the Mecklenburg County Teen Tobacco Use Prevention Advisory Board is to conduct youthled prevention education and advocacy efforts, provide leadership and promote policy changes. This council will provide insight on teen issues that relate to the goals of the Mecklenburg County Teen Tobacco Prevention. Advisory Board membership requires recommendation from an adult who is familiar with the nominee and can provide insight on the nominee's strengths. If this teen is selected to the Advisory Board he/she will conduct efforts in the local community that tie in to statewide efforts.

Qualified nominees will be contacted and given an opportunity to interview with a panel of peers. Nominees should be high school-aged youth with experience in tobacco prevention activities. Students can be rising seniors but due to the fact that we are attempting to create a sustaining effort for next year, we are not currently accepting recommendations for current seniors. Seniors will, however, be included in the panel of peers. Thank you for taking the time to complete a letter of recommendation and for being a supporter of the wonderful youth in North Carolina.

 
Nominee Information
Nominee's Name:
Date of Birth:
Gender:Male
Female
E-mail Address (if known):
Mailing Address
City:
Zip:
Parent/Guardian Name:
Home Phone Number:
Alternate/Cell Phone:
Parent/Guardian E-mail:
Parent/Guardian Phone:
Parent/Guardian Alternate/Cell Phone:
School Name:
Graduation Year:
 
Your Information
Your Name:
Organization:
Job Title:
Address:
City
Zip:
Phone:
Fax:
Relationship to Nominee:
How long have you known Nominee?
E-mail
 
Please rate the following traits about the student:
Tobacco Prevention Knowledge:Execelent
Good
Fair
Public Speaking Ability:Execelent
Good
Fair
Reliability:Excellent
Good
Fair
Teamwork Skills:Excellent
Good
Fair
Leadership Skills:Excellent
Good
Fair
 
Recommendation Narrative
In a narrative 500 words or less, please describe why you recommend this person for the Advisory Board.
 
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