"Nurturing & Creating Alternative Pathways" Sponsorship Program.

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Participant's Name (First & Last Name) *

Participant's Date of Birth? *

Participant's Gender *

Male

Female

Prefer not to say

Other

Participant's age: *

Who does child live with?

Single Mother

Single Father

Both Parents

Grandparents

Other

Race/Ethnicity
*

Black

White

Hispanic/Latino

Asian

Other

How have you been impacted by incarceration or gun violence? *

Immediate family member lost life to gun violence.

Parent/legal guardian incarcerated

Personally experienced gun violence

Is Participant on Free or Reduced Lunch? *

Yes

As Legal Guardian, I Give LFUCG Permission To Post Pictures Of Participants On Social Media & Organization Website In Order To Promote The Progress Of Mentoring Group.

Yes

Parent/Guardian Contact Number

Parent/Guardian Email

Submit

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