Youth Mental Health First Aid Certification Course Registration Name * First Name Last Name Email * Phone * (###) ### #### The Teen Advisory Board meets once a month in person, and engages in special group projects. Approximately how many hours a month can you participate?* Less than 5 hours 5-10 hours 10-15 hours 15-20 hours 20+ hours Please choose the best day(s) for you to participate. Sunday Monday Tuesday Wednesday Thursday Friday Saturday Are there any days you cannot participate? Sunday Monday Tuesday Wednesday Thursday Friday Saturday What is the best time of day for you to meet? 8am to noon noon to 4pm 4pm to 8pm Permission for your image to be used via photos or video as needed for outreach. Yes No Ask me per incident What city and state do you live in? * What is the name of your school? * Please tell us about your background and why you'd like to serve on the Teen Advisory Board? * What do you hope to learn or experience as a Teen Advisory Board member? * Do you and your family speak a language other than English at home? If yes, which language? If you are selected as a Teen Advisory Board member, will your parent or guardian sign a permission form? * This is necessary if you are under 18. Address Address 1 Address 2 City State/Province Zip/Postal Code Country Thank you!
