2021 Virtual Youth Empowerment Summit (YES!) Registration and Pre-Event Survey
Event Date: Saturday, April 24, 2021
Event Time: 9:00 a.m. to 12:00 p.m.
Contact us at: yolosaysyes.com
Email address *
1. Phone number & best time to contact *
2. Full Name *
3. Birth date *
4. Please list primary language (optional)
5. Please list any special needs (optional)
6. Role (Student, teacher, administrator, elected official, partner, other) *
7. Organization/School *
8. Grade level (put n/a if not applicable) *
9. If a minor, provide parent/guardian name / contact information (put n/a if not applicable) *
10. If an elected official, please provide service area (put n/a if not applicable) *
11. Pick the top two topics you are passionate about that you would like to discuss with elected officials? *
12. Have you attended a YES! event before? *
13. If you attended a YES! event before, provide year of event below.
14. How did you hear about this event? *
15. This program will be held virtually over Zoom. We will be providing closed captioning. Are there any other accommodations we can provide to assist your ability to participate? (optional)
16. *Disclaimer* and *Acknowledgment* This program will be recorded. If you do not wish to be recorded you may turn your screen off. To accept, please type "I acknowledge" below. *
Please complete the 'Pre-event survey' below.
You will be given Pre and Post surveys upon participation of the 2021 Virtual YES!. You must complete both surveys in order to be entered in the chance to win a special prize at the end of the event.
2021 Virtual Youth Empowerment Summit Pre-Event Survey
1. Is it important to vote? *
2. Do you understand the role of elected officials? *
3. Do you know the names of elected officials in your town, city or in Yolo County? *
4. I feel comfortable contacting and talking to elected officials about community issues. *
5. I believe my voice matters. *
6. I believe I am empowered to make positive changes in my community. *
7. What do you hope to learn from this year's Youth Empowerment Summit? *
A copy of your responses will be emailed to the address you provided.
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