AACI AMPLIFY Application
Program Description
AMPLIFY is an arts & media program that looks to 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 11 to August 31, 2017
School Year - Week of October 10, 2017 to June 28, 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.

Program Application
First Name *
Your answer
Last Name *
Your answer
Age *
Your answer
Birthday *
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DD
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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?
Your answer
How did you hear about us?
Your answer
Please let us know if you have any additional questions, concerns or comments.
Your answer
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