For Students

CYAC Application

Thank you for your interest in applying to the Congressional Youth Advisory Council. Please fill out the application in its entirety and direct all questions to Corbette Padilla in the Midland District Office at (432)-687-2390.

Required fields are followed by *.

Contact Information

Prefix: *

First Name: *

Last Name: *

Suffix:

Email Address: *

Phone Number: *

Street Address: *

Street Address: (Continued)

City: *

State: *

Zip Code: *

Where do you attend school at?: *

Grade Level: *

Why are you interested in applying to Congressman Pfluger's Congressional Youth Advisory Council?: *

What are you hoping to gain or accomplish from participating in CYAC?: *

Pfluger Fly-By

For Students

CYAC Application