SHE RECOVERS: The Next Generation Youth Action Committee Application Form

To be eligible for a volunteer role within the SHE RECOVERS®: Next Generation Youth Action Committee (YAC), you must be a young woman or a non-binary individual who identifies with women’s communities between the age of 18-35 and able to commit 4-13 hours per month in your role for at least 12 months. Applications are encouraged from individuals who identify as a person in active recovery from a mental health issue, trauma, substance use, and/or related life challenge.

SRF encourages applications for the YAC from members of groups with historical and/or current barriers to equity, including backgrounds that vary by race, ethnicity, social background, religion, gender identity or expression, age, disability, sexual orientation, veteran status, and national origin.

*Denotes a required field.

PERSONAL INFORMATION

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* 1. Name

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* 2. DOB

Date of birth

Date

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* 3. Email

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* 4. Phone number

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* 5. Address

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* 6. With what ethnicity or cultural background do you identify?

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* 7. If different, or in addition to the above, what marginalized identities do you hold?

Person of color

LGBTQ+

Disabled

Living with a chronic illness, pain and/or auto-immune disorder

Neurodivergent

Living in a marginalized body

Veteran

Prefer not to disclose

Other (please specify)

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* 8. With what gender do you identify?

Woman

Non-binary

Two-spirited

Prefer not to disclose

Other (please specify)

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* 9. What are your pronouns?

She/Her

She/They

They/Them

Prefer not to disclose

Other (please specify)

None of the above

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* 10. Please describe your current involvement, if any, with the SRF. (Limit to 100 words).

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