Passaic Youth Task Force Interest Form

Lindsey Meyer Teen Institute Passaic Youth Task Force Interest Form

Hello! Thank you for your interest in joining the LMTI Passaic Youth Task Force. The purpose of the Youth Task Force is to provide youth advocacy and community change to students. We will touch upon addiction & mental health prevention programs that you would like to see in your communities and schools. In addition to this we aim to provide participants with life skills (public speaking, resume building, community service hours, etc.) and other workshops that will help them grow as leaders and as awesome human beings! Please answer the questions below to the best of your ability. If you run into any questions please email mramos@pipnj.org or jramos@pipnj.org
Full Name

First NameLast Name
Preferred Name
Preferred Pronouns (check all that apply)
Student's school email address
example@example.com
Student's personal email address
example@example.com
Parent Name/Legal Guardian Name

First NameLast Name
Parent /Legal Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent / Legal Guardian E-mail address
example@example.com
What grade are you currently in?
What school are you currently attending?
Town of Residence
What do you hope to gain from joining the Passaic Youth Task Force?
What types of skills/activities are you interested in doing during virtual meeting times? (Select all that apply), (if others please specify).

Other
If you are comfortable sharing, is there anything fun or exciting you would like us to know about you?
When meeting new people, would you consider yourself:
What are some extracurricular activities you are involved in school, if any please share with us we would love to know more about you :).
Should be Empty: