Civics Summit TRAINER Application 2019
This is a 3 page TRAINER application for the Civics & Conservation Summit with Alaska Youth for Environmental Action.

The Trainer Retreat will be Sun-Mon, March 3-4th and the Summit will be Tues -Fri, March 5-8th (Saturday March 2nd and Saturday, March 9th will be travel days).

If you are a youth who has not been to the Summit before, you need to fill out the Youth Delegate application, not this one!! Please go here: https://goo.gl/forms/s5atjxE44MLc0GAS2

Deadline to apply: FRIDAY, JAN 11th. Early applications are appreciated.

Contact Margi if you have any problems or questions, 907-347-6201, ayea@akcenter.org.

Thanks for your interest!

Email address *
Legal First and Last Name *
Your answer
Name you prefer to be called
if different than your legal name
Your answer
Mailing Address *
Your answer
City/ Village *
Your answer
Zip Code *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Grade in School *
Home Phone/ Work Phone *
907-XXX-XXXX
Your answer
Cell Phone *
if you don't have a cell phone, write None
Your answer
Gender *
Race/ Ethnicity
optional
Parents'/ Guardians' Names *
If you are applying to be an ADULT trainer, you can write N/A
Your answer
Parents'/ Guardians' phone numbers *
ADULT trainers write N/A
Your answer
Parents'/ Guardians' email address *
ADULT trainers write N/A
Your answer
Which days, times are best for you for conference calls?
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