HelpLine DC-YLC APPLICATION Form

HelpLine DC-YLC APPLICATION Form
HelpLine is launching a high school youth-led council for Delaware County students for the 2024-2025 school year. We are looking for students who are curious, creative and collaborative to join us. Please complete this form as part of the application process.

Questions? Contact HelpLine Youth Empowerment Coordinator, Jackie Lipnos, at jlipnos@helplinedelmor.org.

Basic Information
Full Name of Student*

First NameMiddle NameLast Name
Preferred Name
Email*
Phone Number

School & Academic Information
What school do you attend?*
What grade are you in?*

9101112
How did you hear about the DC-YLC?*

Tell Us About You!
Tell us why you are interested in the DC-YLC?*
Tell us about a passion, interest, skill or strength you have?*
What is one thing that you see/hear/experience in your school or community that you like to change?*
DC-YLC will meet at various locations around Delaware County (libraries, schools, parks). Would you have reliable transportation to/from meetings?*

YesNoSometimes

DC-YLC will meet once a month from 6:00 p.m. - 8:00 p.m. Please check the time that you are available for meetings, starting in October(select all that apply.)*

	Available	Unavailable
Monday
Tuesday
Wednesday
Thursday
Friday

The DC-YLC is a youth-led opportunity that requires commitment and responsibility. All members will help lead discussions and projects. Tell us about a time when you showed commitment and/or responsibility.*
Is there anything else you would like us to know when considering your application?*

Parent/Guardian Information
Please complete the following parent/guardian information.
Parent/Guardian Name*

First NameLast NameRelationship (Mother, Father etc.)
Phone Number*
Email*
example@example.com
Please verify that you are human*
Should be Empty: