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SENIA Youth Chapter Registration Form
Hello! Welcome to the SENIA Youth Chapter Registration Form! Before filling out this form please read through the SENIA Youth Chapter handbook to understand more about the formation of a SENIA Youth Chapter.

Once you submit this form, we will reach out to you within 5-6 business days with a welcome packet to support you in the start up stages of your chapter. If you have any question please don't hesitate to reach out to us at SENIAyouth@somethting.com. Looking forward to hearing from you!
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Email *
Main person of contact/Club leader *
The representative of your chapter will be the main contact for communicating with SENIA Youth, and will step in as the Chapter President. This person should be able to respond to emails quickly!
Chapter president email *
Name of your SENIA Youth inclusion club *
If you are part of a school or organized institution, include the name of your school/organization in the chapter name (for example SENIA Youth @ Amsterdam International School). If you're starting a community chapter in your city, include the city and country name in your chapter name (for example SENIA Youth @ Amsterdam, Netherlands)/
What type of chapter are you forming? *
Adult Sponsor (If applicable)
Adult club sponsor email contact information (if applicable)
Chapter Affiliation (school or organization name) - If applicable
Please fill this out if your chapter is part of your school or affiliated with an institution.
Country *
City *
Zip Code *
What is your SENIA Youth Chapter mission? Keep in mind the SENIA Youth mission of youth activists to advocate and provide resources for differently-abled people through inclusion when creating this.  
SENIA Youth's mission is for youth activists to advocate and provide resources for differently-abled people through inclusion.  Please explain how your chapter's mission will help fulfill this mission. *
So far, how many people are apart of your SENIA Youth club? *
No worries if it's just you at the moment!
What is your plan for recruiting more members? *
How Did You Hear About Us? *
Once you submit we will reach out to you with some introductory resources to help you get started. If you have any questions please visit and contact us by our website SENIAyouth.org
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