UC San Diego Center for Community Health Youth Advancement Collective (YAC) Application
This application to open to all San Diego County high school students. Applications are accepted on a rolling basis. For assistance please contact Nghi Dang at (619) 534-7249 or npdang@health.ucsd.edu.

This application is open to all youth ages 14–19. In accordance with applicable Federal and State law and University policy, the University of California does not discriminate, or grant preferences, on the basis of race, color, national origin, religion, sex, disability, and/or other protected categories.
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Applicant Information
Name (First, Middle, Last) *
Birthday (MM/DD/YYYY) *
Contact Information
Phone Number *
Email *
Zip Code *
Emergency Contact Information 
Guardian Name *
Guardian Phone Number *
Guardian Email *
Guardian Relationship To Applicant *
Demographics
YAC requests this information in order to ensure a diverse and robust cohort of students who come from a variety of backgrounds and lived experiences.
Do you identify as an immigrant (defined as a person who comes to live permanently in a foreign country) or a refugee (defined as a person who has been forced to leave their country in order to escape war, persecution, or natural disaster)?  *
Which of the following best represents your racial or ethnic heritage? Choose all that apply
 *
Required
What languages are spoken in your home? *
Did you or your family ever qualify for any public assistance programs such as Reduced School Lunch, SNAP-EBT, or Section 8?
 *
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