Westchester TIPS Application Fall 2021- Spring 2022
Thanks for your interest in Planned Parenthood Hudson Peconic's Teen Information and Peer Services (TIPS) program! To apply, please fill out this application and a Planned Parenthood staff member will contact you for an interview.

This year, TIPS training will be held Mondays and Wednesdays from 2:45 - 4:45 pm in Room 302 at Riverside High School. From your training, you'll be prepared to teach your peers about sexual and reproductive health topics, and you'll earn 28 hours of community service!

Contact Dana Kaufman at (914) 467-7326 or dana.kaufman@pphp.org with any questions!
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Full Legal Name *
What name would like us to call you?
What pronouns would you like us to call you?
What is your Date of Birth? *
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Phone Number *
Email Address *
What is the best way to contact you? Check all that apply: *
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Name of School *
Current Grade as of Fall 2021 *
Will you be able to attend meetings on Mondays and Wednesdays from 2:45 - 4:45 pm at Riverside High School October-December 2021?
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Are you involved in any other clubs or sports? Which ones?
How will you get home after meetings? (Check all that apply)
Why do you want to be part of the TIPS program?
Do you know anything about Planned Parenthood? If so, what?
This program involves giving presentations about sex, birth control, and reproductive health to large groups of people. How comfortable would you be talking about these topics?  
What are some social issues that are important to you and why? (example: racial justice, environmental rights, mental health)
What are some of your best or strongest qualities? (examples: good listener, fast learner, natural leader)  
What are some skills or qualities you would like help improving on? (example: shyness, temper, confidence)
What are some interests you have outside of school?
What are your goals after high school?
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