SUP Application

Welcome and Thank You!

Thank you for your interest in joining the Be Great For Nate Substance Use Prevention Team! This is a youth group made up of high schoolers that vow not to use substances and make their community a better place!

SUP Team is open to any and all youth of high school age that live in or go to Newport County Schools (Newport, Middletown, Portsmouth, Tiverton and Little Compton).

Please fill out the application and you will be contacted for an interview!

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* 1. Contact Information

First and Last Name

Address

Address 2

City/Town

State/Province

Email Address

Cell Phone Number

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* 2. What is your gender?

Female

Male

Prefer not to say

Other (please specify)

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* 3. What is your race or ethnicity?

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Multiracial or Multiethnic

Native American or Alaska Native

Native Hawaiian or other Pacific Islander

White

Prefer not to say

Another race or ethnicity, please describe below

Self-describe below:

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* 4. What grade are you in?

9th

10th

11th

12th

Incoming 9th grader

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* 5. How old are you?

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* 6. What school do you go to?

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* 7. Parent Contact Information

First and Last Name

Email Address

Phone Number

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* 8. Name and contact of one reference

Name

Relationship to you

Email Address

Phone Number

SUP Application

Welcome and Thank You!

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* 1. Contact Information

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* 2. What is your gender?

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* 3. What is your race or ethnicity?

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* 4. What grade are you in?

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* 5. How old are you?

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* 6. What school do you go to?

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* 7. Parent Contact Information

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* 8. Name and contact of one reference

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* 9. Explain and idea you have to help prevent youth substance use in your community.