Personal Information

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* 1. Full Name

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* 2. Personal Pronouns (check all that apply)

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* 3. I identify my race or ethnicity as... (Check all that apply)

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* 4. Student Email
This will be used to contact you about your application, please make sure it's accessible to you throughout the summer.

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* 5. Student Phone
This is only shared with Teen Leadership Council Staff.

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* 6. Can this phone number receive text messages?

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* 7. Address

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* 8. Birthday (month/day/year)

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* 9. Do you need any special accommodations we should be aware of (hearing, vision, mobility, etc.)? If so, please explain

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* 10. Please share and explain any additional aspects of how you self-identify that you wish to share.
[examples: religion or faith practices, gender identity, sexual orientation, cultural heritage, dietary preferences, etc.]

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* 11. What GRADE will you be in for the upcoming 2026-2027 school year?

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* 12. What school DISTRICT will you be in for the 2026-2027 school year? (if homeschooled, type 'homeschool')

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* 13. What SCHOOL will you be attending for the 2026-2027 school year? (if homeschooled, type 'homeschool')

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* 14. What is your household's income level? (ask a parent/guardian if you are unsure)

Why do we ask? We ask about income level to help ensure our program remains accessible to students from all economic backgrounds. This information allows us to support equitable participation and tailor resources to meet diverse financial needs.

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* 15. Are you related to anyone who works for HealthPartners/Park Nicollet?

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* 16. Are you a new applicant or a returning member?

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