Youth Facilitator Application

First Name *

Last Name *

E-Mail Address

Physical/Mailing Address *

City *

State *

Zip *

Home Phone *

Cell Phone

Date of Birth Month/Day/Year *

Gender *

Social Security Number (Optional for OAD Reporting)

Ethnicity (Optional for OAD Reporting)

Parish Where You Live *

School *

Grade in 2007-08 Year (Current Grade) *

T-Shirt Size *

Why do you want to attend GOT? *

What prevention projects have you been involved in? *

Why do you think it's important for teens to wait until they're 21 to drink? *

Is your personal image consistent with a non-drinking, non-drugging image? Explain.

What do you think is the most effective way to stop teens drom using alcohol and other drugs? *

What experience do you have in facilitating and leading small groups? *

What skills do you think it takes to be a good group leader/facilitator?

I understand that GOT is a training and I will be coming to learn about making a difference in my community. *

I understand that part of GOT will be spent in small groups and I will have the opportunity to share and learn from students across the state. *

I am drug-free and have strong beliefs in the drug-free message. *

I believe that alcohol is a drug and that people should wait until they are 21 to drink. *

I have read and agree to abide by the rules and ethics at GOT *

If you don't agree to the above statements, GOT may not be the right training for you. Explain any special concerns about the statements here.