AHS YP 2023 Registration

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Asian Health Services Youth Program (AHSYP) in Oakland Chinatown supports youth in their journeys towards becoming healthy and thriving community members and leaders. With various programs and plenty of room to touch base on topics including mental health, reproductive health, and additional health resources, AHSYP caters to the current needs of the community.

First Name

Last Name

Is this your preferred name?

Yes

Other:

Birthday

YYYY

Gender

Male

Female

Other:

Race

Black/African American

Native American/Alaskan

Hispanic or Latinx

Native Hawaiian/Pacific Islander

White

Asian

Other:

Ethnicity (If Asian)

Chinese

Japanese

Korean

Vietnamese

Filipino

Indian

Mien

Laotian

Cambodian

Thai

Other:

Preferred Language

English

Spanish

Cantonese

Mandarin

Tagalog

Vietnamese

Other:

Address

City

Zip Code

School

Grade

Phone Number

Which of these are okay with you?

Call

Text

Voicemail

Other:

Preferred Contact

Phone

Other:

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Emergency Contact Name

Emergency Contact Relation

Parent

Guardian

Sibling

Grandparent

Friend

Other:

Emergency Contact Phone Number

Programs you're joining with AHS Youth Program:

GLOW Facilitators (Health - Substance, HIV, Hep C Presentations) | TBD | $150 Stipend | Ages 14-24 | Online

C.H.I.L.L. (Mental Health & Self Care) | Starts 02/27 | M/W 4:30-6PM | $150 Stipend | Online

L.I.T. Leaders (Public Health & Medicine Careers, Substance Use Research, Health Policy) | Starts 9/13 4-5:30PM | $200 Stipend | Ages 14-22 | Hybrid

The Queer Collective (Safe Space for like minded individuals to come together) | TBD

CCSC (Cross Cultural Solidarity; Working for a change in your community) | F 4-5:30 | $100 Stipend | Hybrid

Which of the following do you prefer?

In-Person Programming

Online Programming

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How did you hear about us?

AHS YP Staff

AHS YP Social Media (Instagram, Facebook, etc.)

Flyer

Friend

School

Other:

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