Youth Outreach Squad (YOS) Application- Fall 2019
YOS 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. YOS 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 YOS are due Friday, August 30th, 2019 @5:00 PM
YOS members begin Monday, September 16th, 2019 @5:00 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 50+ 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,: Monday-Wednesday, from 5-7 PM as well as a few special occasions outside the normal hours (weekends, holidays, events, festivals, etc.)
-Youth must commit to full 12 week semester (cannot miss more than 2 weeks)
-Youth must have an interest in health advocacy and community outreach

Email address *
Applicant Information
Full Name (First & Last) *
Your answer
Preferred Name
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Date of Birth *
Cell Phone Number *
Your answer
Email Address *
Your answer
Have you ever participated in a 3rd Street program? *
If yes, which one and when?
Your answer
Name of your middle school & years you attended: *
Your answer
If in high school, name the high school you attend.
Your answer
Applicant Questionnaire
Please complete this to the best of your abilities. Your responses are important upon submitting your application. You must write at least two sentences for each question.
Are you interested in learning about health topics? *
Tell us about your yourself: (Hobbies, talents, things you are interested in, etc.) *
Your answer
Describe the biggest issue in your community & what changes you would like to make: *
Your answer
What does community advocacy and outreach mean to you? *
Your answer
What do you know about the services at 3rd Street Youth Center & Clinic? *
Your answer
Why are you interested in a YOS at 3rd Street? What do you want to gain from this program? *
Your answer
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 *
Your answer
Never submit passwords through Google Forms.
This form was created inside of 3rd Street Youth Center & Clinic. Report Abuse - Terms of Service