2020-2021 UT Teen Health Youth Leadership Council Application
Please fill out all areas and answer questions completely.

Please submit application by June 1, 2020.
Late or incomplete applications will NOT be accepted.
Selected candidates will be contacted for a phone interview.

Questions? E-mail Denise at lewisde@uthscsa.edu or call (210) 567-7036.


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Student's Full Name: *
Student's Date of Birth: *
High School: *
2020-2021 Grade (Mark one circle only):                                                             *
Student’s E-mail: *
Student’s Cell Phone: *
Mailing Address: *
City, State, Zip Code: *
Student's T-shirt Size (Mark one circle only): *
Guardian 1's Full Name: *
Guardian 1's E-mail: *
Guardian 1's Primary Contact Number: *
The number provided is a (Mark one circle only): *
Guardian 1's T-shirt Size (Mark one circle only):                                     *
Guardian 2's Full Name:
Guardian 2's E-mail:
Guardian 2's Primary Contact Number:
The number provided is a (Mark one circle only):
Clear selection
Guardian 2's T-shirt Size (Mark one circle only):                                    
Clear selection
YLC North meets the first Tuesday of every month at UT Health SA. YLC East meets the first Thursday of every month at Biblio Tech East. YLC South meets the 2nd Tuesday of every month at Palo Alto College. YLC West meets the 2nd Thursday of the month at Memorial High School. All meetings are from 5:30 p.m. - 7:30 p.m.  Please select the zone you are applying for (Mark one circle only): *
In the event a zone reaches the capacity of 25 members, please select a second zone choice that you would like to be placed in. This answer must be different from that of the previous question (Mark one circle only). *
Membership in the YLC requires attending meetings and participating in community service projects.  You are only allowed to miss two meetings before being dismissed from the YLC.  Can you adhere to this attendance policy (Mark one circle only)?   *
Do you have access to reliable transportation to and from weekday meetings and weekend events (Mark one circle only)? *
List your extracurricular activities, including any jobs: *
Why are you interested in joining the Youth Leadership Council?  Think it through and be specific. *
Members of the YLC spread the word about health and teen pregnancy prevention. Give us an example of how you promote health at school or in the community. *
Members of the YLC strive to be positive role models and leaders at their school and in their community.  Describe how you are a leader when associating with your peers. *
Members of the YLC develop personally by actively engaging with the school and community.  Name some personal goals you want to set for yourself as a member of the YLC. *
What/Who inspires you to be a leader in your school, club, or life? *
Help us get to know you by telling us more about yourself.   *
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