Summer Health Education Project (SHEP) Application 2019
SHEP members receive comprehensive health outreach training about on-site services, public speaking, project and planning implementation, healthy relationships, STI and HIV prevention, nutrition, reproductive health, & diversity and group facilitation. SHEP represents 3rd Street Youth Center & Clinic by conducting outreach and spreading information learned, throughout the community, via social media, tabling events, and street outreach. Participants will earn a stipend for the duration of the program.

Applications for SHEP are due Monday, May 13th, 2019 @5:00 PM
SHEP members begin Tuesday, June 18, 2019 @1:00 PM
Upon application submission, scheduled interview slots will be assigned

Applications can be submitted via in-person, email or this online form.


Ashia Coleman
1728 Bancroft Ave
San Francisco, CA 94124

Participant Expectations:
-Consistent attendance to workshops
-Help educate 100+ youth through outreach activities including: tabling events, workshops, and street outreach.
-Youth is responsible for keeping up with administrative work assigned to projects, classes, workshops, and outreach. Example: flyers, sign in sheets, final project

-Youth must be 12-16 years old
-Youth must be able to commit to 3 days a week,: Tuesday-Thursday, from 1-3pm as well as a few special occasions outside the normal hours (weekends, holidays, events, festivals, etc.)
-Youth must commit to full 8 week semester
-Youth must have an interest in health advocacy and community outreach
Email address *
Applicant Information
Full Name *
Preferred Name
Street Address
Zip Code
Date of Birth *
Cell Phone Number *
Email Address
Have you ever participated in a 3rd Street program? *
If yes, which one and when?
Do you have any plans this summer that will interfere with the SHEP schedule? (vacations, jobs, camps, other programs). If so, please tell us the dates and times. If no, please say so. *
Name of your middle school & years you attended: *
If in high school, name the high school you attend.
Applicant Questionnaire
Please complete this to the best of your abilities. You must write at least two sentences for each question.
Tell us about your yourself: *
Describe the biggest issue in your community & what changes you would like to make: *
What does community advocacy and outreach mean to you? *
What do you know about the services at 3rd Street Youth Center & Clinic? *
Why are you interested in a summer job at 3rd Street? What do you want to gain from this program? *
Disclaimer & E-Signature
I certify that my answers are true and complete to the best of my knowledge. If this application leads to program enrollment, I understand that false or misleading information in my application or interview may result in my release from programming.
Enter your initials to serve as your e-signature *
Never submit passwords through Google Forms.
This form was created inside of 3rd Street Youth Center & Clinic.