2021-2022 UT Teen Health Youth Leadership Council Application
Please fill out all areas and answer questions completely.

Please submit application by June 28, 2021.
Late or incomplete applications will NOT be accepted.
Selected candidates will be contacted for a phone interview.

Questions? E-mail UT Teen Health at utteenhealth@uthscsa.edu or call (210) 567-7036.

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Student's Full Name: *
Student's Date of Birth: *
High School: *
Classification for 2021-2022 School Year: *
Student’s E-mail: *
Student’s Cell Phone: *
Mailing Address: *
City, State, Zip Code: *
Student's T-shirt Size (Mark one circle only): *
Parent/Guardian #1's Full Name: *
Parent/Guardian #1's E-mail: *
Parent/Guardian #1's Primary Contact Number: *
The number provided is a (Mark one circle only): *
Parent/Guardian #1's T-shirt Size (Mark one circle only): *
Parent/Guardian #2's Full Name:
Parent/Guardian #2's E-mail:
Parent/Guardian #2's Primary Contact Number:
The number provided is a (Mark one circle only):
Clear selection
Parent/Guardian #2's T-shirt Size (Mark one circle only):
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If the YLC can meet in person, UT Teen Health will make every effort to find meeting space in the Zone's area. Please select the Zone you would like to join (Mark one circle only): *
In the event your first Zone choice reaches capacity, please select your second Zone choice. This selection must be different from that of your previous selection (Mark one circle only): *
Membership in the YLC requires attending meetings and participating in community service projects. You are only allowed to miss two meetings before being dismissed from the YLC. Can you adhere to this attendance policy (Mark one circle only)? *
Do you have access to reliable transportation to and from weekday meetings and weekend events (Mark one circle only)? *
If meetings cannot occur in person, would you be able to join virtual YLC Zoom meetings?
Clear selection
Why are you interested in joining the Youth Leadership Council? *
Help us get to know you by briefly telling us about yourself. *
Questions or Comments:
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