Teen Advocacy Program
Epilepsy Foundation New England invites teens living with epilepsy throughout our region to join a powerful and active group with other teens.
The deadline to submit a self-nomination form is Friday, May 1, 2026. Please answer the questions below and provide as much background as possible. You will be required to submit 1-2 paragraph responses to 3 short essay questions. You can also submit a video response to these questions if you prefer. These questions are provided below to help you prepare ahead of your submission. We recommend working on and preparing responses to those questions before you attempt to complete the form. If your essay questions are completed in advance, we still recommend setting aside at least 20 minutes to complete and submit the form to ensure your work is not lost.
Name
*
First Name
Last Name
Birthdate
*
/
Month
/
Day
Year
Date
E-Mail
*
example@example.com
Mobile Number
*
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I would like to
Submit a written essay
Submit a video per question
1. We want to get to know you better so please tell us a little more about yourself! What kind of activities are you engaged in? What do you love to do? (e.g. academics, athletics, hobbies, etc.)
1. We want to get to know you better so please tell us a little more about yourself! What kind of activities are you engaged in? What do you love to do? (e.g. academics, athletics, hobbies, etc.)
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2. Why do you think it is important to advocate or speak up about epilepsy?
2. Why do you think it is important to advocate or speak up about epilepsy?
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3. Why do you believe you would be a good candidate for the Teen Advocacy Program (TAP)?
3. Why do you believe you would be a good candidate for the Teen Advocacy Program (TAP)?
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We strongly encourage self-nominees to obtain a letter of recommendation to accompany their submission.
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Please verify that you are human
*
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