Youth Ambassador Questionaire
Welcome! Thank you for expressing interest in our program, we're so excited to be expanding! Over the next few weeks we'll be looking for strong youth leaders to share our story!

Have a story to share? Want to help out or stop the stigma of mental illness? Are you interested in helping or developing our mission and being involved in future events?

Then we want to hear from you:) Please fill out all the information so we can see how we can best support each other. Thank you in advance!
Full Name *
Email *
Street Address (include zip code) *
Shirt size
Clear selection
If other, please specify
Phone number
Age *
Where did you learn about us?
Example: Instagram, Website, friend, presentation at Worcester Recovery Center etc.
If Other Please Specify
What is your schedule like? *
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