If you are in between schools, which high school will you be attending next year?
Your answer
Which grade will you be entering in the Fall? *
Choose
9
10
11
12
other
What is your cell phone number? *
If you do not have a cell phone number, what is a number where you can be reached at?
Your answer
What is your home phone number? *
If you do not have a home phone number, what is a number where you can be reached at?
Your answer
Who is your emergency contact? *
Please list first and last name
Your answer
What is this person's relationship to you? *
Choose other if none of the options apply.
Choose
Parent
Guardian
Sibling
Cousin
Aunt/Uncle
Teacher/Coach
Friend
Grandparent
Other
What is the phone number for your emergency contact? *
Include area code
Your answer
What is your email address? *
You must be reachable by this email address. Plan to check this email address at least once per day.
Your answer
What is your home address?
This information will be kept confidential.
Your answer
Gender *
Choose
Female
Male
Age *
How are you currently?
Choose
13
14
15
16
17
18
19
20
Ethnicity
What ethnicity do you identify with most strongly?
Choose
White/Caucasian
African-American
Hispanic
Asian
How interested are you in public health? *
Not Interested
Incredibly Interested
How interested are you in teaching your peers about public health? *
Not Interested
Incredibly Interested
How interested are you in starting a Public Health Advocates Club at your school? *
Responsibilities would include creating an after-school club, teaching the Public Health Advocates curriculum, and organizing volunteer service for members.
Not Interested
Incredibly Interested
What other commitments do you have during the school year, besides the school year. Please list hours per week spent on each commitment. *
Please include all activities you feel are applicable. Format your answer as: Name of Activity - Number of hours per week.
Your answer
What strategies do you use to manage your time?
We are looking for techniques you use to balance the different activities in your life. We will not consider entries longer than 200 words.
Your answer
Statement of Interest - Why are you interested in attending this summer session? *
Please limit your responses to 200 words. We will not consider entries longer than 200 words.