Be The Change Youth Council Application 2026-2027
Be The Change (BTC) Youth Council is comprised of individuals committed to making a difference. Their role is to act as a committee, representing students throughout the county. Council Members are asked to make a one year commitment. Members will meet eight times throughout the school year to share ideas, plan and implement peer-focused prevention projects that positively impact their peers and practices designed to promote positive health choices. Students will receive Service-Learning Hours for each meeting they attend and participate in. Meetings will be held virtually except for one in-person meeting. The first meeting will be Monday, October 19, 2026 from 6:30 P.M. - 7:30 P.M. The meeting dates are as follows: Monday, November 09, 2026 | Monday, December 14, 2026 | Monday, January 11, 2027 | Monday, February 08, 2027 | Monday, March 08, 2027| Monday, April 12, 2027 | Monday, May 10, 2027
Youth Information
Student Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Email
*
example@example.com
Birthdate
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
*
Ethnicity
*
Gender
*
Male
Female
Decline to answer
Other
Race
*
White
African-American
Asian
American Indian/Alaska Native
Two or More Races
Other
School
*
Grade
*
Please Select
6th
7th
8th
9th
10th
11th
12th
In 300 words or less, please respond to the following: Why do you want to hold a position on the BTC Youth Council? Why is health promotion important to you? Provide an example of a time when you demonstrated leadership abilities.
*
What health topics would you like to address?
*
How did you hear about the BTC Youth Council?
*
Signature
*
To Be Completed by Parent or Guardian
Name
*
First Name
Last Name
Relationship to Youth
*
Parent/Guardian Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Consent for Participation
I, the undersigned, hereby give my consent for my child to participate in the BTC Youth Council organized by the Baltimore County Department of Health. I understand that participation will involve prevention trainings, community outreach events, monthly meetings, and one in-person meeting. I acknowledge that I am aware of the schedule and commitment required for this program.
Parent/Guardian Signature
*
Emergency Contact
Name
*
First Name
Last Name
Relationship to Youth
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Media Release
I consent to the use of photographs or videos of my child in BTC Youth Council promotional materials, including but not limited to websites, social media, and printed materials.
*
Yes, I consent
No, I do not consent
Liability Waiver
I understand that while BTC Youth Council will take all necessary precautions to ensure the safety and well-being of participants, accidents or injuries may occur. I agree to hold BTC Youth Council and any Baltimore County staff, and volunteers harmless from any claims or damages arising from my child’s participation in the Youth Council.
Parent/Guardian Signature
*
If you have any questions, please contact Asheima Parkinson at aparkinson@baltimorecountymd.gov.
Thank you for your support and cooperation
Submit
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