Friday Night Live Program
The Friday Night Live Program is looking for HMB high school students to join our program. We are seeking students who are interested in making change on campus and in their community. Youth will lead a social media campaign on social, emotional, and physical impacts that alcohol and other drugs have on individuals. Youth may choose between a stipend or community service hours for their contribution. Program runs between September 2022 - Summer 2023. For more information, email Rubi Salazar at
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First Name *
Last Name *
Pronouns *
Birthday (00/00/0000) *
Email *
Phone Number (000) 000-0000 *
Home Address
School/Grade (if applicable)
Why do you want to join the Friday Night Live Coastside Youth Council Program? *
If accepted into the program, would you like to receive a stipend or community service for your participation? *
OPTIONAL: What is your gender?
OPTIONAL: Which of the following best describe you? (Check all that apply)
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This form was created inside of Youth Leadership Institute. Report Abuse