LifeAct Youth Advisory Board Application
LifeAct YAB members and volunteers are vital to LifeAct's success. If you choose to participate as a YAB member with LifeAct, you will help reduce the stigma about mental illness, prevent teen suicide, help young people enjoy healthy, productive lives and support survivors of suicide
Email address *
Name *
Your answer
Date of Birth
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Gender
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Home Phone
Your answer
Cell Phone
Your answer
High School *
Your answer
Graduation Year *
Your answer
Are you a survivor of suicide loss
Person Lost to Suicide
Your answer
Relationship
Your answer
Date of Loss
MM
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DD
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YYYY
Where are you in your healing journey?
Your answer
Why do you wish to serve as a YAB member? *
Your answer
What skill sets will you bring to LifeAct? *
Your answer
Do you belong to other organizations or school Clubs?
If Yes, please list the organization(s)
Your answer
Other relevant experience or comments
Your answer
There are many opportunities for our YAB members to obtain volunteer hours and get involved. Please select those that best suit you.
Electronic Signature
Your answer
Date
MM
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YYYY
Submit
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