Student Application Form Student Application Form 2021Applications are due by Midnight on October 29, 2021. Applications will be reviewed in the order in which they were received. Please enable JavaScript in your browser to complete this form.For the short response questions, please write no more than one or two paragraphs (250 – 350 words). The application should take 15-20 minutes. Name *FirstLastEmail *PhoneHigh School or University *In 2021-2022 school year, I will be a... *FreshmanSophomoreJuniorSeniorOtherWhat is your Race? (please check all that apply)White or European AmericanBlack or African AmericanAsian AmericanNative American or Alaska NativeHawaiian Native or Pacific IslanderOther RaceWhat is your EthnicityHispanicNot HispanicWhat is your gender?FemaleMaleI do not identify as Male or FemaleMy pronouns are: (ex: she/her, they/them, he/them, etc.)Explain why this cause (mental health) is important to you? (One or two paragraphs) *If you could change anything, without limitations, related to the stigma on mental health, what would it be? *Tell us about a time you worked well in a group setting or on a team to accomplish a goal. What was the result of your work? *To confirm you know the dates for the YMHIC, please check below. *November 7 (prep), November 13, 14 For a complete application you must submit the Participant Agreement & Media Release Form using the file upload button below or email the completed form to erin_horn@1n5clone.wfcstaging.com IF YOU NEED THE FORMS, CLICK HERE Media Release - Signed by parent if under 18 Click or drag a file to this area to upload. Participant Agreement - Signed by parent if under 18 Click or drag a file to this area to upload. PhoneSubmit
