Empower RVA Teens 2017-2018 Application
Thank you for taking the time to apply for YWCA Richmond's Teen Peer Facilitation Program, Empower RVA Teens! We look forward to reading your application! Please take some time to read below about the specifics of this program.

About Empower RVA Teens:
The first 8 weeks of this program involves a certification process, during which you will learn the necessary skills and content to be an effective Peer Educator on topics surrounding healthy relationships. You will learn about topics that deal with warning signs of abuse, what constitutes a healthy relationship, how to help friends who are in an abusive relationship, sexual violence, etc. In addition, you will learn public speaking and facilitation skills so that you can feel prepared to talk about these topics with your peers. We also incorporate team bonding activities and games, so that we can all have some fun while dealing with these difficult topics.

After you become a certified Teen Peer Educator, you will then have the opportunity to practice and finesse your public speaking skills through different speaking engagement opportunities for your peers, adults, and other community members. You will also have the chance to learn leadership skills, as you will be in charge of planning, organizing, and managing awareness month events and working on incorporating what you learned into your lives at home, school, and other clubs of which you are a part. You will get the chance to work in groups both with other members of our program and other youth programs in the Richmond area.

Who Can Apply:
High-school-age teens (generally 15-18 years old) in the Greater Richmond area.
Includes anyone enrolled in local high schools, currently home-schooled or not enrolled in any school.

Time Commitment:
The certification process consists of 8, 2 hour, weekly sessions. It is required that participants attend 7 out of the 8 sessions in order to become a certified Teen Peer Educator (pending any extenuating circumstances). Following the certification process, you will be expected to be an active member of this group, which involves working on special awareness month projects, facilitating workshops, and meeting 1-2 times per month with the whole group. A detailed schedule of sessions will be provided prior to the start of the program. We understand that there are probably many commitments in your life, so we will do our best to work with you and your schedule; however, we also appreciate if you work with us to dedicate your time and commitment to this program.

Application Process:
First, submit your online application by July 31st.
Second, you will be contacted by YWCA staff to schedule an in-person interview.
Last, you will be notified about final decisions by Friday, August 18th.
*Note applications will be reviewed and accepted as they come in, so please apply as soon as possible.*

Please direct any questions about the program to Rachael Kaufman, Community Outreach Specialist, by email at rkaufman@ywcarichmond.org or by phone at 804-643-6761 ext. 101.

Email address
Contact information
First and Last Name
Your answer
Phone Number
Your answer
Parent/Guardian First and Last Name
Your answer
Parent/Guardian Phone # and Email Address
Your answer
Who You Are
We would like to know a little more about who you are, where you live, and what you would like to learn and contribute to this program.
Your age
Where do you live?
What grade are you in?
What high school do you attend?
Your answer
Your pronouns
Pronouns are how other people speak about you. How would you like someone to talk about you in the third person? For example, using he/him, she/her, them/they, etc.
Your answer
Your identities
What identities do you have that are important for you to share? This can include sexual orientation (e.g. gay, lesbian, bisexual), gender identity (e.g. transgender, woman, man, agender), race (e.g. Black, Asian, White, mixed) or anything else that makes you YOU.
Your answer
Your skills
What qualities do you have that would positively add to our group? For example, this could be: previous public speaking experience, great listening skills, good sense of humor, knowledge of teen dating violence, etc.
Your answer
Your experience
What experience have you had before with teen programs, volunteering, and/or discussions about healthy relationships and dating violence? It is not a problem if you had not had any experience with this kind of group before!
Your answer
How comfortable are you talking about healthy relationships and dating violence with your peers?
Not comfortable at all
Very comfortable
How comfortable do you feel talking in front of a crowd of people?
Not comfortable at all
Very comfortable
How much do you think you know about healthy relationships and dating violence?
Nothing
Everything
Why would you like to join this program?
Your answer
What is one thing you would like to learn about healthy relationships or teen dating violence?
Your answer
Program Specifics
How did you hear about this program?
Are you able to meet the program time commitment as outlined below?
The certification process of this program involves meeting for eight weeks, every week, for 2 hours each week. In order to become certified as a Teen Peer Educator, you will need to attend at least 7 out of 8 these sessions (pending any extenuating circumstances like illness, family emergency, etc.). Following the certification process, you will be expected to be an active member of this group, which involves working on special awareness month projects, facilitating workshops, and meeting 1-2 times per month with the whole group. A detailed schedule of sessions will be provided prior to the start of the program.
What days of the week are best for you to attend this group? (please select as many as possible).
Required
What is the best time for you to meet during the school year?
Please be as specific as possible. Please also list potential conflicts, or anything else that may prevent you from making the weekly commitment as outlined at the beginning of the survey.
Your answer
How do you plan on meeting at the YWCA Richmond for our meetings?
Reference Name
Please provide a person who can speak to your ability to be ready for and interested in this group. This can be a guidance counselor, religious figure, teacher, employer, etc. Please do not list a family member or friend.
Your answer
Reference Contact Information
Provide an email address, phone number, or both for how we can best contact your reference.
Your answer
Questions? Comments?
Your answer
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