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
* Required
Email address
*
Your email
1. Phone number & best time to contact
*
Your answer
2. Full Name
*
Your answer
3. Birth date
*
MM
/
DD
/
YYYY
4. Please list primary language (optional)
Your answer
5. Please list any special needs (optional)
Your answer
6. Role (Student, teacher, administrator, elected official, partner, other)
*
Your answer
7. Organization/School
*
Your answer
8. Grade level (put n/a if not applicable)
*
Your answer
9. If a minor, provide parent/guardian name / contact information (put n/a if not applicable)
*
Your answer
10. If an elected official, please provide service area (put n/a if not applicable)
*
Your answer
11. Pick the top two topics you are passionate about that you would like to discuss with elected officials?
*
Redistricting & Elections
Health & Mental Wellness
Education
I am an Elected Official so all apply
Youth Engagement Strategies
Human Rights
Social Justice & Racial Equality
Racism & Xenophobia
Environment
Safety
Required
12. Have you attended a YES! event before?
*
Yes
No
13. If you attended a YES! event before, provide year of event below.
Your answer
14. How did you hear about this event?
*
Your answer
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)
Your answer
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.
*
Your answer
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?
*
Yes
No
Not sure
2. Do you understand the role of elected officials?
*
Yes
No
Not sure
3. Do you know the names of elected officials in your town, city or in Yolo County?
*
Yes
No
Not sure
4. I feel comfortable contacting and talking to elected officials about community issues.
*
Yes
No
Not sure
5. I believe my voice matters.
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Yes
No
Not sure
6. I believe I am empowered to make positive changes in my community.
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Yes
No
Not sure
7. What do you hope to learn from this year's Youth Empowerment Summit?
*
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
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