AACI AMPLIFY Application
AMPLIFY is an arts & media program that looks empower youth through creative arts. We use arts & media as a tool to develop leadership skills and community involvement among youth ages 10 - 18.

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

Summer Session - July 11th to August 31st, 2017
School Year - Week of October 10th, 2017 to June 28th, 2018
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Eligibility:
• Must be age 10 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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Daily Schedule:
3PM – 4PM: Homework and Recreational Time
4PM – 6PM: Group Activities

Groups Available:

Explore
*Two days a week (Tuesdays & Wednesdays)
A drop-in friendly group for youth who only have a basic interest in arts & media or are looking to explore new activities. This group is geared toward our younger youth, however, youth of all ages are welcome to participate.
Recommended Ages: 10 - 12

Expressions
*One day a week (Thursdays) - other days open for additional mentoring
For youth who have a strong interest in arts & media and are looking to develop long-term creative and leadership skills. Because this is once a week, a strong commitment will be required.
Recommended Ages: 13 - 18
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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. 404

*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 and the Social Services Agency.

First Name *
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Last Name *
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Age *
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Birthday *
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Address of Residence *
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Phone Number *
Best number to contact you. Please enter 10 digit phone number only with no dashes or parentheses. Ex. 1234567891
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Email *
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Do you want to receive our e-newsletter? *
Join the AMPLIFY mailing list to stay up-to-date with our news and announcements.
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Parent/Guardian Emergency Contact Name *
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Parent/Guardian Emergency Contact Number *
Please enter 10 digit phone number only with no dashes or parentheses. Ex. 1234567891
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What is your preferred method of contact? *
Choose all that apply.
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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?
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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, concerns or comments.
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