Are you an Extension professional with interest or expertise in positive youth development as it relates to adolescent health or well-being? The Building Partnerships for Youth project, a partnership of National 4-H Council and the University of Arizona is developing a database of Extension professionals who have an interest in or work to improve the health or well-being of young people. This database will be available online as a resource for potential collaborators both within and outside the Extension system.

Individuals with a focus on prevention or health promotion as well as youth development professionals interested in working with others in the areas of prevention and health promotion are asked to complete and submit the attached form. The information will then be verified and included in an online database to be housed on the Building Partnerships for Youth website (http://bpy.n4h.org). This database will be marketed to professionals in health, education, faith-based and youth serving organizations across the country as a tool for finding support and collaborators within their own states/communities.


Name:*

Organization:*

Title:* 

Address:
 

Do you primarily work at the*: State Level County/Local Level

State/Providence:*

    

County:*

Email:*

Phone:

Topic Areas of Expertise/Interest*

Abstinence Education
Adolescent Sexuality
Collaboration Building
General Reduction of Risk Behaviors
HIV/AIDS/STD Prevention
Health Education
Marriage and Relationship Education
Physical Fitness/Nutrition
Positive Youth Development
School Dropout Prevention
Substance Abuse Prevention
Teen Pregnancy Prevention
Violence Prevention
Youth/Adult Partnerships
Other (please indicate)

Other:

Contact information for others in your state who have interest in the above areas:

(we will not include anyone in the database without their permission)


(*) Indicates required fields.


This database is funded through Cooperative Agreement Number U58/DP000456-02 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the developers and do not necessarily represent the official views of the Centers for Disease Control and Prevention.