Washington County Health Coalition Student Application
Students are an important part of the process of creating a Healthy community in Washington County. Through your leadership, you will contribute your skills, innovative spirit, and passion to help adults and community partnerships build a healthier generation.

If you enjoy taking action to help others, then this opportunity is for you!

With your participation, we will work towards improving community health for all and enjoy equitable opportunities and prosperity. Some responsibilities include: Assist in identifying community health needs, Participate in developing an action plan to address those needs, Aid in implementing action plan and Serve as a health ambassador.

Before you begin this application, please be prepared to complete each section.
And:
1) Have a reference name and email address. We will be sending them a link to complete the reference form. Reference form can also be found at: https://forms.gle/9hyoEfRjmQ9XfdJp8
2) Parental permission must be given to participate if chosen.

Applications are due by April 14th.

If you have any questions regarding this application, please contact Cindy Sheram or Georgeanne Cook (478) 552-2011.

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Qualifications for Youth Applicant
Applicant must:
1. Be in grades 9th, 10th, or 11th
2. Be a Washington County student
3. Be available to attend regular meetings and events sponsored by the coalition
5. Reference form must be completed by one reference (reference form link will be emailed)
6. Encourage other youth and adults to be involved in community health efforts
Name *
Age *
Grade *
Address (Example: 158 West Haynes Street, Sandersville, GA 31082) *
Email Address *
Phone Number: (Example: 478-552-2011) *
Parent/Guardian Information: (Name and Email Address) *
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