District 5 – Youth Advisory Council

District 5 – Supervisor Vianey Lopez

800 S. Victoria Ave., L#1860, Ventura, CA 93009
Phone: (805) 654-2613
Email: Vianey.Lopez@ventura.org
Office Hours: Monday to Friday, 8:00 a.m. to 5:00 p.m.

Communities Represented:
Central and Southern portions of the City of Oxnard, City of Port Hueneme, Oxnard Plain, Oxnard Shores, Mandalay Bay, Silver Strand, Hollywood Beach, Hollywood by the Sea, Channel Islands Harbor, California State University Channel Islands, Naval Base Ventura County, California Air National Guard, Oxnard Airport, Ormond Beach Wetlands, and Channel Islands National Park.

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Youth Council
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Home
About Supervisor Vianey Lopez
District Map
Services
Contact Us
Monthly Newsletters
- Subscribe to District 5 Newsletters
Youth Council
- Bylaws

Youth Advisory Council

Hello,

I am thrilled to announce the launch of the District 5 Youth Advisory Council. This is a fantastic opportunity for young voices to be a part of the policy making and decision-making process for our community.

The District 5 Youth Advisory Council is a group of 10 to 15 Youth Commissioners selected by my office, to advise me on issues related to youth in the Fifth District. As members of the council, youth will collaborate with fellow Commissioners and my office to share ideas and help shape policy.

Your perspective is valuable, and I want to hear what you have to say. If you are interested in applying, complete the webpage application here on my website, or submit your application via email at District5@ventura.org.

The deadline to apply is Sunday, October 27th

The first meeting is scheduled for November 18th, location TBA.

I look forward to collaborating with you.

Sincerely,

Vianey Lopez
Supervisor, 5th District

Youth Advisory Council Forms

The District 5 Youth Advisory Council is a group of 10 to 15 Youth Commissioners selected by County Supervisor Vianey Lopez. The Youth Advisory Council will advise Supervisor Lopez on local issues in Supervisorial District 5 and will offer an opportunity for youth to get involved locally. The term for commissioners will be one year with the possibility for an extension if you reapply. This is a voluntary commission, and the meetings will take place on the 3rd Monday of the month from 5:00pm to 6:30pm unless otherwise noted. A District 5 staff member will assist the council with scheduling and clerical tasks.

To be considered for this commission, you must complete the application below, a photo release form and if applicable, a parental consent & waiver form.

If you have questions about the commission or the application, you may contact the District 5 office at district5@ventura.org or at 805-654-2613. Please email your complete application and attachments to: district5@ventura.org with the subject line: ‘First Name, Last Name-YC Application’ if you decided to submit your application via email.

DISTRICT 5 YOUTH ADVISORY COUNCIL APPLICATION PACKETS

Downloadable Application Packet

Click the link below to download the application packet:

DISTRICT 5 YOUTH ADVISORY COUNCIL APPLICATION PACKET (PDF format) – DOWNLOADABLE FORM

Online Application Packet

Complete and submit the application packet below:
3 Sections: I. APPLICATION – II. PARENT CONSENT & CLAIM WAIVERS – III. PHOTO RELEASE FORM

I. APPLICATION

1. First and Last Name?

First Last

2. What are your Pronouns?

3. How old are you?

Please enter a number from 0 to 20.

4. Do you live, work, or go to school in District?

Yes

Type address HERE to confirm.

4b. If "yes", please explain.

5. Email Address

6. Phone Number

7. Please select your most recent education experience

Certificate Program (online or in-person)

College or University

High School Diploma or GED

Military

Trade School

N/A

Other

8. What grade are you in?

9. What are your fields of interests?

Agriculture

Education

Environment

Healthcare

Homelessness

Housing

Mental Health

Public safety

Transportation

10. Why would you like to become a Youth Council Commissioner?

11. What motivates you to get up every morning?

12. What do you like to do for fun?

13. As this position will be an appointment by the District 5 Supervisor, you will be serving the Supervisor’s office in an official capacity at the discretion of the Supervisor. This is a voluntary position, and no compensation is included. Please acknowledge below that you both understand and agree to this statement.

I understand and agree to the above statement.

I do not understand and/or agree to the above statement.

II. PARENT CONSENT & WAIVER CLAIMS

Acknowledgement(Required)

I acknowledge that this form has been completed by a parent or guardian.

I hereby authorize my child,(Required)

Full name of child

to participate in the District 5 Youth Advisory Council program activities. My child is currently in good physical and medical condition. In the event that my child becomes ill or injured, he or she may receive First Aid.

In case of emergency, my child may be admitted to a hospital. I agree to hold harmless the County of Ventura, its officers, agents, and employees for medical aid rendered. I will also reimburse the County of Ventura for medical or other expenses incurred for medical aid on behalf of my child.

I understand and acknowledge that the County of Ventura does not provide medical insurance for the District 5 Youth Advisory Council activity participants. I hereby release the County of Ventura, its officers, agents, and employees from all liability, demands or claims from any loss, damage or injury resulting from participation in the District 5 Youth Advisory Council, and do hereby give consent for my child to receive emergency treatment.

Date(Required)

MM slash DD slash YYYY

Name of Parent or Guardian(Required)

Full Name

Address(Required)

Street Address City Zip Code

Cell Phone(Required)

Work Phone(Required)

Child's Medical Information

Doctor(Required)

Doctor Name

Phone(Required)

Existing Medical Conditions(Required)

Allergic To(Required)

Special needs(Required)

III. PHOTO RELEASE FORM

Acknowledgement(Required)

I acknowledge that this form has been completed by a parent or guardian.

I hereby give the County of Ventura and the District 5 Youth Advisory Council permission to use my name, statement, photograph, and likeness for promotional, advertising and media purposes. My picture may be used alone, as a member of a group, in a composite or in such other manner as will most favorably serve to promote and advertise the District 5 Youth Advisory Council. My picture may be used with or without my name supporting the District 5 Youth Advisory Council. I agree there will be no compensation to me for the use of my image now or in the future.

Date(Required)

MM slash DD slash YYYY

Name(Required)

Student Full Name

Address(Required)

Street Address City Zip Code

Legal Guardian Name (if under 18 years of age)(Required)

Full Name

Supervisors

Government

Departments

Emergency Services

Health and Human Services

Ventura County

Employment

Residents

VISITORS

ENVIRONMENT

Youth Advisory Council

Youth Advisory Council Forms

DISTRICT 5 YOUTH ADVISORY COUNCIL APPLICATION PACKETS

Downloadable Application Packet

Online Application Packet

I. APPLICATION

II. PARENT CONSENT & WAIVER CLAIMS

Child's Medical Information

III. PHOTO RELEASE FORM

Contact Info

Information

Photo Gallery

© 2024 - County of Ventura

Supervisors

Government

Ventura County

Employment

Residents

VISITORS

ENVIRONMENT

Youth Advisory Council

Youth Advisory Council Forms

DISTRICT 5 YOUTH ADVISORY COUNCIL APPLICATION PACKETS

Downloadable Application Packet

Online Application Packet

I. APPLICATION

II. PARENT CONSENT & WAIVER CLAIMS

Child's Medical Information

III. PHOTO RELEASE FORM

Contact Info

Information

Photo Gallery

© 2024 - County of Ventura

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