UpStreet Youth Advisory Board Application
Name *
First and last name
Phone number *
Email *
How should we contact you? *
Birthdate *
MM
/
DD
/
YYYY
Gender and preferred pronouns
Do you identify as LGBTQ+ ? *
How would you describe your race or ethnic background? *
Are you in school? *
If you are in school, tell us the name of your school and what grade/year you're in. *
What other activities (school, community, religious, extracurricular), if any, do you participate in? *
How has mental health impacted your life? *
Why are you interested in serving on the Youth Advisory Board? *
What else should we know about you?
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