LEAH Teen and Parent Advisory Board - Teen Application

The UW LEAH Teen and Parent Advisory Board will advise adolescent healthcare providers across multiple fields including medicine, nutrition, social work, psychology and nursing. Share your perspective and help to improve healthcare for teens. Meet to:

Collaborate with healthcare providers
Gain valuable leadership experience
Earn community service hours
Educate health providers about the teen experience
Create and develop projects related to improving teen healthcare
Discuss topics such as:
- Mental health and stress
- Substance use and abuse
- Healthy lifestyles
- Sexual and reproductive health
- Confidentiality and your rights

First Name

Last Name

Phone Number

Email address

Please confirm your email

City/Town

State/Province

ZIP/Postal Code

Best way to reach you

Call

Race/ethnicity (check all that apply)

American Indian or Alaskan Native

Asian

African American / African / Black

Hawaiian Native or Pacific Islander

Hispanic / Latino

White / Caucasian

Other…

School you attend

Grade

Preferred Pronouns

Optional. Example: she/her, they/them, he/him

Why do you want to be a part of the LEAH Advisory Board?

How can the LEAH Teen Advisory Board benefit from selecting you as a member?

Please consider the following and add comments below about any statement you cannot check:

I am willing to make at least a one year commitment to the LEAH Teen Advisory Board with the opportunity to serve up to 2 additional years, unless circumstances merit my resignation/removal.

I understand this includes attending 8-11 meetings, working on projects for a potential additional 2 hours between meetings and attending 2 Friday afternoon seminars.

I have regular email and internet access and will respect the importance of checking and responding to email regularly. I will adhere to appropriate video conferencing etiquette.

Additional comments or information, which may be helpful in considering your application:

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