The 2022-2023 Tobacco-Free Rhode Island Youth Program Application
Please reach out to Zoe.Moreau@lung.org or call 401-864-4422 with any questions or to learn more! You can also visit http://www.tobaccofree-ri.org/ambassador-program.htm for an overview of the program.
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What level of engagement are you interested in? *
What is your first and last name? *
(This name will be used on name tags, in social media posts, for events, in conversations, etc. Please put whatever name you'd like to go by, whether that be a nickname or something completely different from your birth name.)
What are your pronouns? *
ie: she/her; he/him; they/them; she/they; he/they; I prefer not to identify; etc.
Is there any time we should not use these pronouns? *
TFRI cares about the safety of our youth and will do everything we can to make sure each of you are happy and safe in any setting. Sometimes people are not out to their parents and prefer other pronouns to be used in emails, text, or on calls with them. Please let us know below if there is ever a time your pronouns should change based on the audience. If your pronouns are safe to use anywhere to anyone please type N/A.
Cell phone number WITH area code *
ie. 401-864-4422 (type N/A if you do not have one)
Email *
Please try not use a school email, list a personal one you check often.
What city/town do you MOST associate with (live in)? *
Please list the city/town you represent the most.
Full main address: Where should we send any mail? *
Please list: street, town, state, zip, apt/unit # 
ie: 32 Smith Street, North Providence, RI 02865, Apt #221
Please list any additional cities/towns you associate with. *
ie: I go to school in Bristol half the year at Roger Williams University; I live in Warwick in the summer; etc.
What school will you be attending in the upcoming year? *
Please include name of school and city/town and state. ie: University of Rhode Island, South Kingstown RI; Cumberland High School, Cumberland RI; I won't be attending a school in the fall; etc.
What grade level will you be entering? *
ie: 8th grade; freshman in college; senior in high school; won't be in school; etc.
When is your birthday? *
Include month, day, year
How old are you? *
Check off all the days/times that work for you: *
Our meetings will be both in-person and online via zoom. Events will mostly be in-person.
Required
(if under 18) Parent/Guardian name (first & last or type N/A) *
(if under 18) Parent/Guardian phone number WITH area code (or type N/A)
 *
(if under 18) Parent/Guardian email address (or type N/A)
 *
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