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COVID Youth Ambassador Corps
APPLICATION DEADLINE: JANUARY 18, 2021
Event Registration
COVID Youth Ambassador Corps
Name
First Name
Last Name
Contact Info
Address
Country
Address Line 1 *
Address Line 2
City *
State/Province *
Postal Code *
Email
Cell Phone
About You
Birthdate
Month
January
February
March
April
May
June
July
August
September
October
November
December
Month
/
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
/
Year
Age
School
Parent/Guardian Information (Please fill out if applicant is under 18 years old.)
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Parent/Guardian Name(s)
Home Address (if different from above)
Country
Address Line 1
City
State/Province
Postal Code
Phone Number
Email Address
Do you have access to a phone, tablet, laptop or desktop computer that you can use to connect to Zoom?
Yes - all the time
Sometimes
No - not at all
What do you hope to gain from participating in this program??
Why do you want to join this program?
How have you personally been affected by COVID-19?
How have you personally been affected by COVID-19?
What has influenced your decision to get/ not get vaccinated?
What has influenced your decision to get/ not get vaccinated?
What is one barrier that prevents people from getting vaccinated?
What is one barrier that prevents people from getting vaccinated?
How would you interact with someone who was hesitant to take the vaccine?
How would you interact with someone who was hesitant to take the vaccine?
What qualities would you contribute as a COVID-19 youth ambassador?
What qualities would you contribute as a COVID-19 youth ambassador?
What strategies would you use to spread awareness of vaccine information?
What strategies would you use to spread awareness of vaccine information?
How did you learn about COVID Ambassador Corp?
Email
Family
Friend
Flyer
Print
Social Media (Facebook, Instagram, etc)
Word of Mouth
Other
SHOP Registration
SHOP Registration for School Sites
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About
About
Board & Staff
Funders
Careers
Contact Us
Programs
Program Categories
Community Safety
Sacramento Youth Violence Prevention Collective
SHOP
Live Well South Sac
SHOP: Ladies First
LISTOS- Disaster Readiness
Economic Well-Being
Ventanilla de Asesoria Financiera Y Proteccion al Patrimono (VAF)
Workforce Development
Health Access
Invest Health Roseville
West Sacramento Accountable Communities for Health Initiative
Healthy Food Access
West Sacramento Housing
Ventanilla de Salud (VDS)
Placer County Accountable Communities for Health Initiative
Social Connection
Peers Helping Peers
Facilitadores Comunitarios
Walk with Friends
Mente Sana, Vida Sana
Cal HOPE
Wellness Education
Nutrition Education Obesity Prevention
Afghan Community Programs
Impact
Impact
Latest News
Photo Gallery
Connect
Upcoming Events
Events This Month
Future Events
Donate
Volunteer
Join Our Mailing List
Request our Help
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