The Advocacy Institute #RealTalkTobacco Rolling Application
The Advocacy Institute is a twelve-week youth empowerment and training program operated out of Health Promotion Council located at 1500 Market Street, Philadelphia PA 19102. The Advocate Institute seeks to empower youth to create sustainable changes through media, policy and community advocacy. #RealTalkTobacco is a class series designed to address an issue that impacts all of our health: Tobacco. The cohort experience will focus on advocating against Tobacco companies that target vulnerable populations as well as educate community members, stakeholders, and youth alike all about the dangers of tobacco use. Please be advised that this is a rolling application for all future 2019 #RTT Cohorts beginning in the Winter. Upon submitting your application, you will be contacted regarding cohort logistics and acceptance status.
Email address *
Today's Date *
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Which #RealTalkTobacco cohort do you prefer? *
First Name *
Your answer
Last Name *
Your answer
Email *
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Cell Phone *
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Home Phone
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Street Address *
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City/ State/ Zip *
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Current School
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Current Grade *
Date of Birth *
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I identify my gender as *
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Please check the racial/ethnic backgrounds that apply to you *
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I have the following special dietary requirements
I have the following allergies and medication requirements
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Please list any special learning requirements or special needs that our staff should be made aware of to accommodate you during your time with us at The Advocacy Institute
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What is your T-Shirt Size? *
How did you learn about the program? Please check the appropriate answer: *
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