HelpLine DC-YLC APPLICATION Form

HelpLine DC-YLC APPLICATION Form
HelpLine's youth-led council for Delaware County students for the 2025-2026 school year is back. We are looking for students who are curious, creative and collaborative to join us. Please complete the application below to join!

Questions? Contact Felicia Robinson at frobinson@helplinedelmor.org for more information.

Parent/Guardian Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Parental Permissions*

I give permission for my student to participate in the HelpLine Delaware County Youth-Led Council (DC-YCL) and its associated events.I give permission to HelpLine to use photos, video footage taken during DC-YCL activities for the general purposes of social media, websites, newsletters or brochures to promote the council.I give permission for medical attention to be sought in the case of an emergency. I will also expect to be notified of any medical situation that may arise.
Signature*

Clear
Relationship*
ex. Father, Mother, etc.
Date*

MonthDayYear
Date

School & Academic Information
High School Name*
Grade*
Resume or List of Achievements (OPTIONAL)

File should be in pdf, doc/docx format.
Cancelof
Extra Curricular Participation

Student CouncilClass OfficerClub/OrganizationSportsOthers (please specify below)
Other Extra Curricular Activities
Interests*
Why do you want to join the DC-YLC?*
Please verify that you are human*
Should be Empty: