2019 Summer CPA Youth Programs Interest Form
Please fill out the following form and our staff will contact you within a week. If you aren’t sure how to answer a question you can leave it blank or write “I don’t know.”

If you have any questions, please email us at youthprograms@cpasf.org

Applications are due **May 31st, 2019 at 6pm**!

**Note: Regular School year MOJO participants still need to reapply for MOJO’s summer program!
CPA’s Summer Programs

Note: people can choose to participate in one, two, or all three programs because dates and times do not overlap!

Youth Movement of Justice and Organizing (Youth MOJO) @ CPA 1042 Grant Ave:
Youth MOJO develops the leadership of Chinese high school youth in San Francisco, with a focus on social issues such as healthcare, education, immigration, and workers’ rights. Youth leaders develop leadership, communication, advocacy and organizing skills. Our program aims to empower youth to make a positive change in their community! Each year, Youth MOJO leaders must attend a 4 day-3 night Youth Leadership Retreat in Lake Tahoe (June 10-June 13, 2018) and MOJO orientation (Fri. May 17, 2018).

Gender and Sexuality Diversities (GSD) @ CPA 1042 Grant Ave:
Gender Sexuality Diversities (GSD) Program was created in 2013 to meet the needs of Asian American youth members for a safe space to explore gender and sexuality issues. GSD supports queer, questioning and ally youth in understanding power, privilege, and oppression more deeply, as well as their own experiences around gender identity and sexual orientation. GSD is open to all youth, and is centered in supporting queer and questioning youth.

BREATHE:
BREATHE is a space to unpack and explore our mental and emotional health, wellness, and healing. Through sharing personal stories, experiences, and the ways we survive, we will engage with topics such as depression, anxiety, body image, conflict, self-worth and other topics of youth’s choice. Through this gathering space, we aim to build and strengthen coping and resilience skills and strategies.

Common Roots Youth Leadership Program:
Common Roots is a 7-8 week youth leadership program for working class Chinese and Latino youth in San Francisco. Since 1997, Common Roots has been providing hands-on opportunities for youth to learn about environmental justice as well as cross-cultural and cross-racial awareness. This summer, Common Roots youth will support MOJO's mental health campaign.

Important Dates to Note:

Youth Leadership Retreat (YLR) at Lake Tahoe (June 10-June 13,2019) is encouraged for MOJO participants. Common Roots participants are not required to attend.

Summer program begins June 10th-13th with our retreat, then picks up with regular programming June 24, 2018, and ends August 9, 2019

Summer Orientation (mandatory for ALL MOJO participants) is on Fri. May 17, 2019 5-7 pm at CPA’s office (1042 Grant Ave, 4th Fl).

**Weekly Summer 2019 Program TBA**

Basics
Which Youth Program are you interested in?
Check all that apply!
Are you a current MOJO Member?
First Name *
Your answer
Last Name *
Your answer
Name you prefer we use
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Birth City *
Your answer
Email *
Your answer
Cell Phone *
Your answer
Home Phone *
Your answer
Address *
Your answer
City: *
Your answer
Zip Code: *
Your answer
School *
Your answer
Grade (for the 2018-2019 school year) *
What is the best way to contact you? *
FB, phone (call or text), other method of contact
Your answer
What would you say best describes your gender identity? *
Required
What would you say best describes your sexual identity? *
Required
What is your race? *
If you selected Asian, what is your ethnicity? *
Do you identify as an immigrant?
If Yes, what year did you immigrate?
Your answer
Do you come from an immigrant family?
Parents are immigrants, etc.
What languages do you speak and how fluent are you in the language? *
(example: Cantonese, very fluent; Mandarin, somewhat; Spanish basics, etc)
Your answer
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