Thank you for taking a moment to fill out the our Youth Council Interest Form. If you are between the ages of 13 - 26, please complete the following questions. 

To respond to the unique needs of teens and young adults, the National Domestic Violence Hotline launched love is respect as the National Dating Abuse Helpline in 2007. After over a decade of operating, love is respect was refreshed in 2020 with a new brand and enhanced youth-informed resources.

A big focus for love is respect is to engage directly with youth so their experiences and needs around healthy relationships and relationship abuse prevention has representation in the work, services, and resources.

This opportunity is only open to those in the U.S. or U.S. territories.

Please answer each question to the best of your ability. If you have any questions, please email love is respect Director Angela Lee at alee@thehotline.org.

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* 1. First Name

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* 2. Last Name

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* 3. Pronouns

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* 4. Date Of Birth

Date

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* 5. Address

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* 6. Email Address

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* 7. Phone Number

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* 8. Race (Optional)

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* 9. Gender (Optional)

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* 10. School/University/College attending

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* 11. School/committees (include if any leadership positions)

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* 12. Extracurricular activities/organizations and community service:

Short Answer Questions: Please answer the following questions in approximately 500 characters (roughly 100 words).

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* 13. What does a healthy relationship mean to you?

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* 14. If you took over love is respect social media for a day, what would you post?

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* 15. What is your favorite quote and why?

Essay Question: Please answer the following question in essay format in 3,000 characters (roughly 500 words) or less.

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* 16. What is one of the biggest issues you feel youth face today and how would you solve it?

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