AACI AMPLIFY Application
Program Description
AMPLIFY is an arts & media program that takes place during the summer and after school. Throughout the program, youth learn about a variety of arts & media topics and create original projects while also building leadership skills as part of an alcohol and other drugs prevention effort. AMPLIFY aims to empower youth through creative arts, using arts & media as a tool to develop team-building skills and community involvement among youth ages 9 - 18.

Weekly Meetings:
Tuesdays, Wednesdays, and Fridays 3PM – 6PM

School-year Session: September 25th, 2018 to June 21st, 2019
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Eligibility:
• Must be age 9 through 18 at the time of enrollment
• Must live in the Santa Clara County
• Must have transportation to and from our office
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Groups Available:
Our programming is provided through the following two groups:

Explore
• Two days a week (Tuesdays and Wednesdays)
• A drop-in friendly group for youth who have a basic interest in arts & media or are looking to explore new activities. This group is geared toward younger youth; however, youth of all ages are welcome to participate.
• Recommended Ages: 9 – 13
• Time: 3PM – 6PM

Expressions
• One day a week (Fridays)
• For youth who have a strong interest in arts & media and are looking to develop long-term creative and leadership skills. Because this group meets only once a week, a strong commitment and high level of participation will be required.
• Recommended Ages: 13 - 18 (Exceptions made only if youth can demonstrate a strong sense of interest)
• Time: 3PM – 6PM
• If you are truly interested in participating in Expressions, please apply through the special Expressions application --> https://www.bit.do/amplifyexpressions
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Activities provided at:
AACI Story Road Office
749 Story Road, Suite 50
San Jose, CA 95122

Applications will be accepted any time. If the current session is full, you will be placed on a waiting list.

For all questions and concerns, please contact amplify@aaci.org or 408-975-2730 ext. 489

*AMPLIFY is a program of Asian Americans for Community Involvement (AACI). Services from AMPLIFY are funded by Santa Clara County Behavioral Health Services Dept. - Substance Use Prevention Services.

Program Application
First Name *
Your answer
Last Name *
Your answer
Age *
Your answer
Birthday *
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Address of Residence *
Your answer
Phone Number *
Best number to contact you. Please enter 10 digit phone number only with no dashes or parentheses. Ex. 1234567891
Your answer
Email *
Your answer
Do you want to receive our e-newsletter? *
Join the AMPLIFY mailing list to stay up-to-date with our news and announcements.
Required
Parent/Guardian Emergency Contact Name *
Your answer
Parent/Guardian Emergency Contact Number *
Please enter 10 digit phone number only with no dashes or parentheses. Ex. 1234567891
Your answer
What is your preferred method of contact? *
Choose all that apply.
Required
Name of School *
Your answer
Grade *
During the summer, please choose the grade you will be entering.
Which group are you interested in joining? *
Have you ever participated in any of AACI's youth programs? *
If yes, what AACI youth programs have you participated in? When?
Your answer
Do you have any medical conditions or dietary restrictions/allergies or learning difficulties we should be aware of?
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How did you hear about us?
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Please let us know if you have any additional questions, comments, or concerns.
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