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Teen Advisory Council interest form

Teen Advisory Council interest form

Please fill out the form below and we will get in touch with you.

Full name

Age

Date of birth

Gender

Race

Address

City

State

Zip code

Phone

E-mail

Name of high school or college

Year in high school or college

Are you (Select all that apply) A former or current patient A sibling of former/current patient A Children's volunteer

How did you learn about Teen Advisory Council (please select one) Internet Children's staff member Family or friend

Have you reviewed the TAC Standards and Contract Agreement? Yes No

Would you be able to adhere to all guidelines and responsibilities outlined in the TAC Standards and Contract Agreement? Yes No

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