Application - 2018-2019 Mental Health Awareness Project (MHAP), a project of Youth Advocacy Corps
THANK YOU for your interest in applying to be part of YAC's Mental Health Awareness Project!

★Please Note that the program runs from November 2018 through December 2019. We will meet two times weekly, and all participants will receive stipends for participation. Applicants should be between 16 and 24. ★

INSTRUCTIONS: Complete this application for Youth Advocacy Corps and submit it ASAP. Please be sure to answer every question and do not leave any blank.



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Email *
PART 1: PERSONAL INFORMATION
Name *
Full Address *
Please tell us where you live (Street, City, State, Zip Code)
What neighborhood do you live in? *
(i.e., Sunnyside, Crown Heights, Harlem).
Phone Number *
Email Address *
What is the best way to reach you? *
Required
What is your date of birth? *
MM
/
DD
/
YYYY
THE FOLLOWING THREE QUESTIONS ARE REQUIRED IF YOU ARE UNDER 18:
Name of Adult Contact Person: *
What is your relationship to Adult Contact Person: *
(i.e., father, mother, legal guardian, foster parent, aunt, uncle)
Phone number and/or email address of Adult Contact Person: *
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