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UCLA Friends of Semel Teen Advisory Council
This application is for high school students interested in participating on The Friends of Semel Teen Advisory Council
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Cell Phone #
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender identity
Female
Male
Non-binary
Agender
Clear selection
Which if any of the following groups do you identify with?
Caucasian
African American
American Indian
LatinX/Latino/Latina
Asian
Other:
How did you hear about FOSI TAC?
*
A friend or relative
My school
Social media
I’ve attended previous FOSI events
Other:
Education
Tell us about your academic home - this information is helpful to us to ensure we have representation from diverse institutions.
Name of School
*
Your answer
City and state of school
*
Your answer
Intended year of high school graduation
*
Your answer
About you
Help us understand the special sides of you and what you’d bring to the FOSI teen advisory council! Your answers will help us facilitate this program and will be kept confidential. We respect your privacy and look forward to learning more about you through these short answers.
What do you enjoy doing in your spare time?
*
Your answer
Which areas of mental health do you believe would resonate most with teens and why?
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Anxiety
Bullying
Depression
Relationships/Friendship
Social Media challenges
Eating Disorders/Body Image
Option 7
Other:
Required
If you are comfortable, please share some of your experiences or concerns about mental health issues.
Your answer
In 4-6 sentences, tell us why you’re interested in participating and what you would like to bring to the conversation.
*
Your answer
We know you are very busy! In 4-6 sentences, tell us about your current commitments and how FOSI TAC would fit in with your other priorities.
*
FOSI TAC is an action-based committee that relies on the participation of its members to further the mission. The time commitment will vary depending on programming. We anticipate approximately 4-6 hours per month.
Your answer
Parent or Guardian Acknowledgement
Finally, we are asking for your parent or guardian's contact information.
Parent or Guardian First Name
*
Your answer
Parent or Guardian Last Name
*
Your answer
Parent or Guardian Email Address
*
Your answer
Home Address
*
Your answer
Parent or Guardian Phone Number
*
Your answer
A copy of your responses will be emailed to the address you provided.
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