2014 National Youth Advisory Board Application

A Message From the NYAB Chair

Thank you for your interest in joining the NYAB. We are looking for individuals who are dedicated to ending dating violence and speaking out about healthy relationships. If you are between the ages of 13 and 22 please complete the following application and we’ll be in touch with you soon.

I love being a part of the NYAB for loveisrespect.

Being a Youth Advisory Board Member has given me the great resource of the website to introduce through my advocacy work to my own community, but even more than that it has given me connection with a couple dozen other activists who are actively working toward a world free of dating violence. I have had an amazing experience in my past year as a board member and I cannot wait to see the amazing things we will do in the next year and the years to come.

I hope you’ll join us –- we look forward to adding new members to our board.

Melissa Siegel, NYAB Chair

PS Remember, applications are due February 28th!

Basic Information

Contact Information

Schooling Information


Please list your current extracurricular commitments or activities (clubs, sports, leadership positions, jobs, community service experiences, religious commitments, family responsibilities or other activities that take up your time). If the activity is seasonal (example: a fall sport) please note that.

Short Answer

Please answer the following questions in 1,500 characters or less.

 Mandated Reporting Disclosure:The following questions may contain sensitive subjects. Please be mindful of your responses on this application. All reviewers of the application must follow mandated reporting procedures. If you indicate that you are in a current abusive relationship or if reviewers of the application feel that your response indicates immediate danger or harmful behavior your application and information will be submitted to proper authorities as deemed necessary by your state's child abuse laws.




Please "sign" below by typing your name and the date as an applicant and getting your parent and/or guardian to do the same if you are under 18.