SPF100 Youth Leadership Application Date: ______________

Applicant Information

Full Name: Age: First Last M.I.

Address: Street Address Apartment/Unit #

City State ZIP Code

Phone: ( ) E-mail Address: Best time to call you?

School Attending & Grade Level:

Can you serve as a Drug and Alcohol - Free Positive Youth Role Model for Somerville Teens?

YES

NO

Are you involved in school and/or community activities? If yes, please list ALL below.

YES

NO

Are you available to participate in SPF meetings every Thursday 3:30-5:30PM, plus 2hrs of project prep per month, and attend 2-4 SPF events, Nov thru April?

Yes

No

List all school and/or community activities including: work, clubs, sports & volunteer:

Write why a teen may use alcohol, tobacco, and other drugs and how SPF can help these youth. (add a page if necessary)

List your skills and experiences that will help make you a good SPF100 Youth Leader.

References

Please list one reference that is not related to you (school, work or volunteer).

Full Name: Relationship:

Company: Phone: ( )

Address:

Signature If this application leads to an interview, you will be contacted by telephone. If you have questions regarding this process, please contact: Lovelee Heller at lheller@somervillema.gov or (617) 625-6600 x4322 please leave a voice message.

Please sign & date your application. Return to SCAP, 50 Evergreen Ave, Somerville, MA 02145 or lheller@somervillema.gov Youth Signature:

Parent/Guardian Signature: Date:

APPLICATIONS Due!!! Email to: Lheller@somervillema.gov or

Mail to: SCAP, 50 Evergreen Ave, Somerville, MA 02145

Somerville Cares About Prevention Somerville Health and Human Services Department 50 Evergreen Avenue Somerville, MA 02145 (617) 625-6600 x4322 lheller@somervillema.gov

SPF100 Somerville Positive Forces

Make a Difference! We are looking for energetic high school youth, ages of 13-19, to serve as leaders as part of a team that addresses community issues related to drug use, underage drinking, bullying and mental health. What SPF100 Youth Leaders Do:

• Serve as a Drug/Alcohol-Free Positive Youth Role Models for Somerville Teens and around prevention efforts;

• Promote solutions and supports for issues that Somerville youth face; • Create TV/Media Public Service Announcements to educate the community about

issues related to youth drug and alcohol use; • Conduct awareness campaigns to prevent harm to youth and promote positive

norms to support a healthy community; • Collaborate with city leaders and organizations to support group goals.

The Benefits: Join Other Youth Leading Positive Change! Get up to a $600 stipend for full participation in all SPF100 meetings & activities; Make new friends, connect with leaders, and earn 60 volunteer hours; Build your resume and college application! It’s FUN! It’s Service! It Matters! Work Schedule: Every Thursday: 3:30PM-5:30PM Plus 2hrs of Project Prep/Implementation each Month And Attend 2-4 SPF Special Events Total: 10-12 hours per month November thru April

For More Info Contact Lovelee Heller 617-625-6600 x4322 or lheller@somervillema.gov