Form

Youth Advisory Board (YAB) and Youth Advisory Affinity Group (YAAG) Application

First name*

Last name*

Preferred Name

Phone Number

DCFS ID#

Birthdate*

Race/Ethnicity*

Gender Identity*

Street address

City

State/Province

Zip Code

Placement Type*

Check current placement type

*Required* Which are you interested in applying for?

Please select a maximum of two groups which you are interested in participating in. Allies are welcome to participate in both YAAG Groups.

How did you hear about this opportunity?*

Signature*

Date*

Month/Day/Year

Questions? Please reach out to:
YAB@bestrongfamilies.net
(800) 805-2505 Ext 3