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Home | Youth | Youth Ambassador Program | Youth Ambassador Role, Responsibilities, and Time Commitments | Community Contact Form and Agreement

Community Contact Form and Agreement

Community Contact

ACT Missouri requires each Youth Ambassador to have a community contact who is at least 21 years old, passionate about substance use prevention, and committed to living a healthy lifestyle. Community contacts may be a teacher, counselor, coach, pastor, mentor, etc. Community contacts will support the student in his or her efforts to develop leadership and advocacy skills. Upon returning from training, the Youth Ambassador may call on the community contact to help plan and promote community service and substance-free activities. Community contacts are welcome to attend trainings and activities with the Youth Ambassador.
  • Project Director may send occasional text messages
  • Community Contact Agreement

    I have reviewed and understand my role as a community contact. *Note: Initialing below serves in the same capacity as your personal signature.
  • Date Format: MM slash DD slash YYYY

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Info For Our

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ACT Missouri Blog

Dec 06

Prevention Happened Here!

Dec 03

National Drug Take Back Totals

May 26

Prevention Wins Were Lean in 2019

Contact Us

428 E. Capitol, 2nd Floor
Jefferson City, MO 65101
phone: 573-635-6669
toll-free: 877-669-2280
fax: 573-635-7257
email: info@actmissouri.org

Prevention Resource Center Locator

Contact your local Prevention Resource Center to find out more about what’s going on in your community and how you can make a difference!
Get a map or see list of locations

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  • Students Against Destructive Decisions (SADD)
  • Missouri Youth/Adult Alliance
  • Partnership for Drug-Free Kids

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