EmailMe Form - Statewide Leadership Team Application (New Member)

Name:

First Last

Pronouns (optional):

Chapter:

High School:

Which grade will you be in in Fall 2020:

Phone Number:

Email:

Home Address (street, city, state, zip code)

Birthday (mm/dd/yyyy):

The 84 strives to have a team of diverse leaders across different racial and ethnic backgrounds and gender identities. The following questions are completely optional and help us to select a team that is representative of the diverse group of youth in our movement.

Race:

Ethnicity:

Gender Identity:

Questions

The program operates with regular weekly meetings from September-June. Most meetings occur on Sunday evenings from 7:00-8:00 PM, and Monday evenings whenever there is a Monday holiday. All meetings will be clearly listed on the meeting schedule sent to participants. There will be in-person and more frequent meetings around peak event planning times. During these times, Sunday meetings may extend to 8:30 PM. The following events require mandatory member attendance at the Health Resources in Action office, when it is safe to do so (2 Boylston St., Boston, MA):

Youth Power Summit In-person meeting- TBD weekend day in October/November

Youth Power Summit- TBD weekend day in October/November

Kick Butts Day In-person meeting- TBD weekend day in March/April

Kick Butts Day- TBD weekday likely in April

Are you able to commit to the time commitments described above?

Yes

No

What other after school activities or work are you actively engaged in? What is the time commitment for each of them and how would you manage your time if selected to the SLT?

Please answer the following questions in at least 3-4 sentences each.

Why do you want to join the Statewide Leadership Team? What would you like to get out of the year?

Why are you passionate about tobacco prevention and/or racial justice? Please share your story.

How would you use your leadership role on the SLT to impact your community?

How have you been or will you be involved in your Chapter?

What other experiences have you had in a leadership role? (This can include any leadership experiences, even being an older sibling or cousin). Describe what you learned. If you haven’t been involved in a leadership role before, please describe why you are interested in taking on a leadership role with The 84.

What makes for a good member of a team? How do you contribute to teams you’re part of?