• 2022-2023 Application

    By, With & For Youth
  • We're so happy you are taking the time to apply to be one of our youth ambassadors! We recommend that you look over all of the questions before beginning the application.

    Take your time & good luck!

  • If selected, you may be asked for further documentation to support the data you provide. Likewise, all correspondence will be generated from the personal information submitted below. So, please use proper spelling, capitalization and punctuation.

  • I. Personal Data:

    Tell us about yourself
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  • Optional Information:

    Information regarding gender, ethnic origin and race are optional.

  • I. Parent/Guardian Data:

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  • Parent/Guardian Signature

    Media Release Permission
  • By signing (typing your legal name) in the space below, you are  agreeing to and giving consent that North River Prevention Partners (NRPP) and their respective affiliates, subsidiaries, licensees, successors and assigns may use any video, still photo, or voice recordings taken of your son/daughter/ward during his/her time as a NRYC ambassador, or any reproduction thereof, in any form, style, or color, or media, together with any writing and/or other advertising and/or publicity material in connection therewith, including the use of his/her name as they may select.  NRPP shall be the exclusive owner of such taping, photography, and recording with the right, throughout the world, an unlimited number of times in perpetuity, to copyright, to use, and to license others to use, in any manner, all or any portion thereof or of a reproduction thereof in connection with NRPP or otherwise.

  • II. High School Information:

  • VI. Extras:

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  • 0/300
  • Meeting Information

  • VII. Why do You Want to Become a North River Youth Ambassador?

  • In a few complete sentences, please explain why you want to become a North River Youth Ambassador and your thoughts on being part of a coalition that promotes an alcohol, drug & nicotine free lifestyle for youth.

  • 0/500
  • VIII. Applicant's E-Signature

  • By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application.

    Additionally, by signing you are agreeing to and giving consent that North River Prevention Partners (NRPP) and their respective affiliates, subsidiaries, licensees, successors and assigns may use any video, still photo, or voice recordings taken of me during my time as a NRYC ambassador, or any reproduction thereof, in any form, style, or color, or media, together with any writing and/or other advertising and/or publicity material in connection therewith, including the use of my name as they may select.  NRPP shall be the exclusive owner of such taping, photography, and recording with the right, throughout the world, an unlimited number of times in perpetuity, to copyright, to use, and to license others to use, in any manner, all or any portion thereof or of a reproduction thereof in connection with NRPP or otherwise.

    When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.

    Thank you for your submission.

  • North River Youth Coalition

    By, With & For Youth
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    North River Prevention Partners is committed to equal opportunity in employment and education. We do not discriminate in any program or activity on the basis of race, color, religion, gender, age, national origin, disability, or any other protected class.

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