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BeWell Student Leader Application 21 - 22
* Indicates required question
Email
*
Your email
First Name
*
Your answer
Middle Initial
Your answer
Last Name
*
Your answer
Student ID Number (your personalized HO#), if you know it
Your answer
School Name
Your answer
Email
Your answer
Social Security Number (this is requested for you to easily receive your incentive check, however, if you don't have an SSN, you may still apply).
Your answer
Home phone number
*
Your answer
Other phone number
Your answer
Home language
English
Cantonese
Mandarin
Spanish
Other:
Clear selection
Address
*
Your answer
City
Your answer
Zipcode
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Ethnicity - Check all that apply
*
African American
Other Black
Asian-Chinese
Asian-Filipino
Asian-Indian
Asian-Japanese
Asian-Korean
Asian-Laotian
Asian-Other
Hispanic/Latino-Mexican/Mexican American
Hispanic/Latino-Central American
Hispanic/Latino-South American
Hispanic/Latino-Caribbean
Hispanic/Latino-Other
Middle Eastern-Arab
Middle Eastern-Iranian
Middle Eastern-Other
Multiracial/multiethnic
Native American / Indian
Native Alaskan
Pacific Islander-Guamanian
Pacific Islander-Hawaiian
Pacific Islander-Tongan
Pacific Islander-Samoan
Pac. Islander-Other
White- French
White- Irish
White- Russian
Other White
Declined to state
Other:
Required
Grade Level
6th grade
7th grade going into 8th grade
8th grade
Other:
Clear selection
Gender
Female
Male
Transgender
Gender queer / nonconforming
Something Else
Decline to Sate
Other:
Clear selection
SFUSD Email Address
Your answer
Anything else you would like us to know about why you would be a good student leader.
Your answer
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