LearnServe International: Youth Advisory Board Application 2021-22

Thank you for your interest in the LearnServe Youth Advisory Board! Please complete the following application to join. All required fields must be completed. Your application cannot be saved and completed at a later time.

Questions? Contact Florence Rivkin at florence@learn-serve.org.

Demographic Data

First Name *

Last Name *

Email *

Cell Phone *

Home Phone *

School *

If you selected "Other", please write it below:

School Type *

Expected high school graduation year *

Ethnicity (please check all that apply) *

African-American
African
Asian
Caucasian
Hispanic
Middle Eastern
Native American
Native American or Alaskan Native
Mixed (two or more)
Other

What are you preferred pronouns?

Date of Birth (mm/dd/yyyy) *

Do you receive free or reduced price lunch from your school? *

Do you receive Medicaid benefits? *

Street Address *

City *

State *

Zip Code *

Ward/County *

Name of your school advisor *

Email address of your school advisor *

Parent/Guardian Information

Parent/Guardian 1 First Name *

Parent/Guardian 1 Last Name *

Parent/Guardian 1 Email *

Parent/Guardian 1 Cell Phone

Parent/Guardian 1 Home Phone

Parent/Guardian 1 Relationship *

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Email

Parent/Guardian 2 Cell Phone

Parent/Guardian 2 Home Phone

Parent/Guardian 2 Relationship to you

LearnServe Experience

I have participated in (check all that apply): *

LearnServe Fellows Program
LearnServe Abroad Program
Seeding Social Innovation – a school-based social entrepreneurship course
Other (please describe below)

If Other, please describe:

Application Questions

You can answer these in sentences or bullet points - up to you! 2-4 sentences/points are fine for each question!

Why do you want to be on the LearnServe Youth Advisory Board? *

Do you see yourself as a leader? Why or why not? *

What are 1 or 2 things you would add or change about the LearnServe program you participated in? How could it be improved? *

What types of skills would you like to build during your time as an Intern? *

Event & Project Planning
Representing LearnServe
Teaching or Facilitating Sessions
Communications & Marketing

We have 5 Sub-Committees you can join! What is your first choice? *

What is your second choice Sub-Committee? *

Are you interested in being the CHAIR or the VICE-CHAIR of the Youth Advisory Board? *

Yes, I'm interested in the Chair Position
Yes, I'm interested in the Vice-Chair Position
Yes, I'm interested in both positions
I'm not sure
No, I'm not interested in being Chair or Vice-Chair

Will you be able to commit 5 hours of your time per month to the Youth Advisory Board? *

Yes
No
I'm not sure

Do you have access to Zoom through a computer or phone? *

I have talked to my parent(s)/guardian(s) about applying to the LearnServe Youth Advisory Board. *

Please fill out the captcha on the right.

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LearnServe International: Youth Advisory Board Application 2021-22

Demographic Data

Parent/Guardian Information

LearnServe Experience

Application Questions