S.T.A.N.D. Out 's 2017-2018 Applications now being accepted!!!
S.T.A.N.D. OUT (Speaking Truth and New Direction) YOUTH ADVOCACY & DRUG PREVENTION PROGRAM APPLICATION

Our Mission is to promote the health and wellness of youth and teens throughout the state; by working to eliminate health disparities in communities of color. We utilize innovative substance abuse prevention tools, health advocacy and education programs.

Our Activities:
❖ Information about the effects of use of marijuana, tobacco and other drugs.
❖ Develop educational materials, prevention tools – with use of media
❖ Provide peers with healthy social activities that provide an alternative to using drugs
❖In person presentations to schools, community centers, churches
❖Recruiting within friend communities (sports teams, drama group)
❖Social Media
❖Field Trips

For more information about the Center for MultiCultural Health and the Stand Out Program call contact Me’Kyel Bailey 206-461-6910

This program is specifically for youth ages 12-18 who identify as African, African-American and/or Black. Do you identify as any of the above options?
Name
Your answer
Address
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Email
Your answer
Gender
Preferred pronoun. Examples: he, her, hers and he, him, his, They, them, theirs, Ze, hir, Ze, zie or xe
Your answer
Are you in middle school?
Are you in high school?
Name of School
Your answer
Parent/Guardian Name
Your answer
Parent/Guardian Cell Phone
Your answer
Parent/Guardian Other Phone
Your answer
Parent/Guardian Email
Your answer
1. Please describe any community or volunteer service you have participated in with your school, faith-based, church or community organizations.
Your answer
2. What do you want to get out of this advocacy program?
Your answer
3. Do you have any prior activist/organizing experience? Any special skills you want to tell us about? What issues are you most passionate about?
Your answer
4. Stand Out is a drug prevention youth group. In 3-5 sentences explain the importance of being drug-free and/or having the proper information to live a healthy life.
Your answer
5. Do you expect to have another seasonal job or other plans that you would have to schedule around the Stand Out Youth Program?[Please make sure your other commitments do not conflict with these hours.You are required to be present for the entire program. The program will have gatherings and activities during the summer. The program will run through the school year starting in September. Our meetings will be on weekends.
Your answer
Please list 2 adult references other than your parents or immediate family members. Please include phone numbers and/or email
Your answer
Is there anything else you want to add on your behalf?
Your answer
Thank you for your application!
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