UpStreet Youth Advisory Board Application

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Name *

First and last name

Phone number *

Email *

How should we contact you? *

Phone

Birthdate *

YYYY

Gender and preferred pronouns

Do you identify as LGBTQ+ ? *

Yes

Prefer not to answer

How would you describe your race or ethnic background? *

Are you in school? *

Yes

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?

Submit

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