Origin Youth Group Sign Up Form Spring 2021
Do you want to create a project that can better your community? Join our Origins Youth program!

We are the Origin Youth group, a Youth Leadership cohort working with the Coalition for a Better Chinese American Community (CBCAC). We are working on an issue-based project for the summer. We want to create a solution so that our communities are better for us and learn some skills along the way!
We will explore topics/skills like Asian American identity, civic engagement, organizing, issues in our community, collaboration, leadership development, communication, and more.

***Students are eligible for a $150 stipend upon completion of the program***

- Weekly 1.5 hour meetings on Sundays at 12:30pm from February - June. You do not have to commit to the summer, but note that we will be implementing the project then.
- Orientation is Saturday 2/20/21 at 12pm. If you can't make it, let us know!
- All meetings are virtual until further notice.

Everyone who fills this form will be admitted into Origin and we are flexible with capacity. We are looking for a diversity in ages, identities, and backgrounds. We welcome all interests and past experiences.

Eva Nip evanip@cbcacchicago.org
Darek Lau dareklau@cbcacchicago.org
What is your first + last name? *
What is your email? *
We will be contacting you through email, so please put down one you check!
What grade are you in?
Clear selection
How did you hear about Origin?
Clear selection
Can you come to the online orientation on Saturday, 2/20 at 12pm? *
This is not a requirement to joining the program.
Can you come to our online weekly meetings on Sundays 12:30pm-2:00pm? *
We meet over Zoom. Let us know if you need support accessing it!
Do you need any support to come to our meetings? (ex: tech, visual aid, audio aid, translation, etc)
What kind of participation are you looking for with Origins?
We want to understand where you are at and how much capacity you have for the program! This does not affect how we view your engagement nor will it negatively affect your participation.
I just want to listen in and absorb information
I am energetic and ready to work on a project!
Clear selection
How do you want your community to change in the next 5 years? What issues do you care about?
What skills would you like to learn? (Choose as many as you want)
The following demographic questions are optional and only for us to understand who is interested in Origin. We will not share this information, use it for any other purposes, or use it to discriminate.
What school do you go to?
What is your age?
What is your zip code?
What is your racial/ethnic identity?
We understand the intersection of identities. Thus, you may self-identify with whatever you are comfortable with.
What pronouns would you like us to use for you?
Clear selection
Thank you for filling out the interest form! We will contact you shortly about next steps and more details.
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