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.

Question Title

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

Friend

Teacher or School staff

Parent

Social Media (Twitter, Facebook)

Flyer

Dare to Dream Youth Leadership Conference

Other (please specify)

Question Title

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

Yes

No

Question Title

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

Question Title

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

Question Title

* 5. What is your name?

Question Title

* 6. What is your email ?

Question Title

* 7. Are you interested in participating in the Dare to Dream opening skit at the University of Rhode Island on May 23, 2024?

Yes

No

Maybe