A&A Application

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A&A Application

For members looking to join the Act & Advance program as part of Youth Ambassadors of Service, please complete the following application. For more information about this program, please check out the 2026-2027 Act & Advance Syllabus.

First Name *

Last Name *

Email *

Phone Number *

Preferred Pronouns *

What high school will you attend in the upcoming school year? *

What grade will you be in the upcoming school year? *

Mailing Address *

Guardian(s) Name *

Separate by commas as necessary.

Guardian(s) Email
*

Separate by commas as necessary.

Guardian(s) Phone Number
*

Separate by commas as necessary.

Please share a 3-5 sentence bio about who you are in the third person. *

Your Date of Birth

YYYY

Gender Identity *

Describe however you would like.

Race/Ethnicity *

Check all that apply.

American Indian/Alaskan Native

Asian American

Black/African American

Hispanic/Latinx

Native Hawaiian/ Pacific Islander

White/Caucasian American

Other

Required

Do you identify with any of the following? *

Please select all that apply. Reminder that this information will not be shared.

Youth with Disabilities

Youth who are Homeless

Youth in the Foster System

Youth in the Juvenile Justice System

Youth who are Immigrants or Refugees

Youth who are ESL Learners

Youth from Military Families

Youth who are LGBTQIA+

None of the above

I prefer not to answer.

Other:

Required

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