HelpLine DC-YLC APPLICATION Form

HelpLine DC-YLC APPLICATION Form
HelpLine's youth-led council for Delaware County students for the 2026-2027 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 Brittany Wolf-Delawder, Youth Engagement Coordinator at bwolfdelawder@helplinedelmor.org.
- Full Name of Student
  
  First NameMiddle NameLast Name
- Email
- Phone Number
  Format: (000) 000-0000.
- Birth Date
  
  MonthDayYear
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- 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.Format: (000) 000-0000.
- Parental Permissions
- Signature
- Relationship
  ex. Father, Mother, etc.
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Emergency Contact
  
  First NameLast Name
- Relationship
  ex. Father, Mother, etc.
- Emergency Contact Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Emergency Contact Email
  example@example.com
- High School Name
- Grade
- Resume or List of Achievements (OPTIONAL)
  
  File should be in pdf, doc/docx format.
  Cancelof
- Extra Curricular Participation
- Other Extra Curricular Activities
- Interests
- Why do you want to join the DC-YLC?
- Please verify that you are human
- Should be Empty: