GLSEN LA Chapter Member Interest

GLSEN LA Chapter Member Interest

Chapter Members must complete a background check conducted by GLSEN every 2 years. Please expect a GLSEN LA Chapter Member to respond to your Interest Form within 5-7 business days.
GLSEN LA is open to Chapter Members of all ages!

All youth (<18 years old) must complete this application along with their parent or guardian. Parent/guardian signature is required.

Adults (18 and up) please make sure you fill out all relevant sections.
Your Information
Full Legal Name*

First NameLast Name
Preferred Name*

First NameLast Name
Pronouns*
Email Address *
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Have you completed a background check within the last two years?*
If you are selected to join as a Chapter Member, you will be required to complete a background check every 2 years. It is not required to have already completed a background check at the time of this interest form.
I agree to complete a background check every 2 years via GLSEN's policies and procedures.*

Applicant Questions
Current or Most Recent Occupation
Please upload your resume (.pdf format only)

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Chapter Members will typically serve a two-year term and are a Chapter Member or a Chapter Member Leader. Expectations of your time commitment as a Chapter Member include:
- Attending 2 hour monthly Board Meeting on Zoom
- Attending a minimum of 2 quarterly Chapter events
- Timely responses to emails
Please take the time to read about the Open Chapter Roles & Responsibilities
I am applying for the following Chapter Roles (check all that apply):

Policy LeadSupporting Chapter Member
Please explain why you would be a good fit for the position. (300 words max per position)
Why do you want to be involved with GLSEN LA and what do you hope to contribute as a Chapter Member? (300 words max)
How did you hear about GLSEN LA?
If there is anything else you would like to provide (e.g. link to online portfolio, website, LinkedIn, social media, etc.) or anything else you'd like us to know, please add it here.
If you were referred to the application/have any relationship with a current or former GLSEN LA Chapter Member, please write their name(s) below and the nature of your relationship:
I agree to complete an Interview (30 minutes-1 hour) on Zoom with GLSEN LA Chapter Members.
I certify that the information in this form and any attached documents is true and correct.
Please type your full name below.
Date signed

MonthDayYear

Chapter Member Details (Youth)
Youth (<18 years old) are eligible to apply to be a GLSEN LA Chapter Member and will typically serve a one-year term. Expectations of your time commitment as a Chapter Member include but are not limited to:
- Attending 2 hour monthly Board Meeting on Zoom
- Attending a minimum of 2 quarterly Chapter events
- Timely responses to emails
Please take the time to read about the Open Chapter Roles & Responsibilities
Youth Applicant's Parent/Guardian Information
Parent/Guardian Legal Name

First NameLast Name
What is the relationship to the Youth Applicant?
Example, Parent or Guardian
Please note that the parent/guardian of Youth Applicant will be contacted by a GLSEN LA representative to discuss details of Youth Applicant's participation.

If the parent/guardian is unable to be contacted by a GLSEN LA representative, for whatever reason, Youth will not be able to move forward with their application to be a Chapter Member for GLSEN LA.

In the event of an emergency, the parent/guardian will be contacted by a GLSEN LA Chapter Member.
Parent/Guardian Phone Number
Please enter a valid phone number.
Parent/Guardian Email
Please enter a valid email address. example@example.com
As part of the application process, the Youth Applicant will need to complete an Interview (30 minutes-1 hour). The interview will be conducted on Zoom with at least one of the GLSEN LA Co-Chairs and one other GLSEN LA Chapter Member. The Youth Applicant must be able to be on camera/video on Zoom for the duration of the interview. The Youth Applicant may choose to have you (Parent/Guardian of Youth Applicant) present during the interview or they may participate in the interview by themself. The interview will be rescheduled if any technical difficulties that occur. The GLSEN LA Chapter Members will ask the Youth Applicant about their motivation to become a Chapter Member as well their time management skills, and may include the following questions:
- Please explain why you would be a good fit for the position of Youth Advisor.
- Why do you want to be involved with GLSEN LA and what do you hope to contribute as a Chapter Member?
- We are committed to you prioritizing your education above your responsibilities as a Youth Advisor. How will you manage your obligations as both a K-12 student and a Chapter Member?
- How did you hear about GLSEN LA?
- How have you interacted with GLSEN LA before (have you attended any events, seen us tabling, waved at us at Pride, etc)?
The Youth Applicant will not be asked to disclose their physical address or personal identifying information at the time of the interview.
I, the Parent/Guardian of Youth Applicant, certify that the above statements are true and I understand that the Youth Applicant is applying to be a Chapter Member for GLSEN LA. I give permission for the Youth Applicant to complete an Interview (30 minutes-1 hour) on Zoom with GLSEN LA Chapter Members.
Type your full name to sign this form.
Date signed

MonthDayYear

Youth Applicant Questions
Youth (<18 years old) are eligible to apply to be a Chapter Member. The Youth Advisor will typically serve a one-year term. Expectations of your time commitment include but are not limited to:
- Attending 2 hour monthly Board Meeting on Zoom
- Attending a minimum of 2 quarterly Chapter events
- Timely responses to emails
Please take the time to read about the Open Chapter Roles & Responsibilities
What school do you attend?
For example, Panorama HS, Venice HS, Harvard-Westlake MS, homeschooled, online/remote school
Please upload your resume (.pdf format only)

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Please explain why you would be a good fit for the Chapter Member position you're applying for. (300 words max)
Why do you want to be involved with GLSEN LA and what do you hope to contribute as a Chapter Member? (300 words max)
We are committed to you prioritizing your education above your responsibilities as a Chapter Member. How will you manage your obligations as both a K-12 student and a Chapter Member? (300 words max)
How did you hear about GLSEN LA?
How have you interacted with GLSEN LA before (have you attended any events, seen us tabling, waved at us at Pride, etc)?
If you were referred to the application/have any relationship with a current or former GLSEN LA Chapter Member, please write their name(s) below and the nature of your relationship:
I, the Youth applicant, agree to complete an Interview (30 minutes-1 hour) on Zoom with the Co-Chairs.
I, the Youth applicant, certify that the information in this form and any attached documents is true and correct.
Type your full name to sign this form.
Date signed

MonthDayYear

One last thing! Please note that your interest form will not be submitted until you click the "Submit" button below.

We send out email newsletters about once a month, sometimes more frequently depending on if there is an event coming up. You are not required to sign up to receive our email newsletters in order to submit your interest to become a Chapter Member.
I would like to have the following email address added to GLSEN LA's newsletter/list serve. I understand that I may unsubscribe at any time, and this will not impact my ability to become a Chapter Member.
example@example.com
Should be Empty: