KYM Application Form
What is Kentucky Youth M.O.V.E. (KYM) Council?

Kentucky Youth MOVE is a group of youth and young adults devoted to helping their peers experiencing behavioral health challenges. The group has members who are from all across Kentucky and have a behavioral health diagnosis.

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Email *
KYM's Misson
Kentucky Youth MOVE will provide advocacy and training. share their lived experiences with others, help to create a youth-guided peer to peer network, partner with other organizations to help them understand youth behavioral health challenges, and create a culturally competent youth led system of care.
KYM's Vision
Kentucky Youth MOVE will create a statewide network to help all youth entering a youth serving system to reach their fullest potential, be empowered, persevere, share their voice and be self-sufficient in living a life without stigma.
Who can be a KYM Member?
To be a member of KYM, you must be 14 to 26 years old and have a behavioral health diagnosis. You must also wish to positively impact the experiences of other young people with behavioral health challenges in Kentucky.
When does the KYM Council Meet?
The KYM Council meets four to five times a year to work on their focus areas. Meetings are usually in Frankfort, KY. Mileage reimbursement is given for members to attend meetings. We are currently meeting only online at this time!  
Name: *
First and last name
Date of Birth: *
Phone Number: *
Email: *
Street Address: *
City/State: *
School: *
Grade/Year: *
If you are under 18 years old: Parent or Guardians Name: Parent/Guardian Phone #:
If applicable, do you have an Individualized Education Plan (IEP) or 504 plan at school? *
Are you employed? *
Please list any extracurricular activities, groups, accomplishments, or awards: *
What is your diagnosis? *
At what age did you get diagnosed? *
Have you been on the KY Youth M.O.V.E. Council before? *
If yes, include reason for stepping off the Council.
Do you have reliable internet and/or technology? *
If not, how will you attend the meetings?
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