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Apply to be a PEER Ambassador

Please complete the following application to become a PEER Ambassador. 

 

The application should be completed by students and signed by parents before submission. 

 

There is no cost for PEER Ambassador training.  

 

If you have any questions, please contact CYFA at contact@cyfadvocacy.org 

Become a PEER Ambassador

"*" indicates required fields

STUDENT INFORMATION

Name*
MM slash DD slash YYYY
Please enter a number from 1 to 12.
Home Address*

PARENT/GUARDIAN INFORMATION

Parent/Guardian Name*
Address (if different from the student)

PERSONAL INTEREST STATEMENTS

The following statements must be completed by the student.

EMERGENCY CONTACT INFORMATION

Emergency contact name*

AGREEMENTS & WAIVERS

Student Consent
Parent/Guardian Consent*
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