Youth Advisory Council Interest Form

Rhode Island Department of Health Youth Advisory Council Interest Form

Want to learn more about the YAC? Fill out this short form and someone will get back to you with additional information.

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* 1. How did you learn about the RIDOH Youth Advisory Council?

Friend

Teacher or School staff

Parent

Social Media (Twitter, Facebook)

Flyer

Other (please specify)

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* 2. Are you a young adult between the ages of 14-23?

Yes

No

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* 3. Are you a professional who works with youth and would like to learn more about our program?

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* 4. What is the best way to contact you?

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* 5. What is your name?