2017 YEY Student Application
Please fill one application per student.

Youth Empowering Youth’s program takes place every Saturday from ¬- November 2017 through July 2018. Each session is approximately 3 hours long. Regular field trips will be a part of the program. YEY participants are expected to attend all sessions. To remain in the program, participants may miss no more than three sessions. Attendance of the first session is mandatory. Participation in all class projects is required. Candidates should have the support and commitment of their parent(s) or guardian(s).

By submitting this form, I understand the requirements of Youth Empowering Youth. I will devote the time to complete the program. Participation in leadership activities after the program year is encouraged. I have the support and consent of my parent(s) or guardian(s).

Full Name
Your answer
I prefer to be called
Your answer
Date of Birth
MM
/
DD
/
YYYY
Home Address
Your answer
Home Telephone
Your answer
Cell
Your answer
E-mail
Your answer
Student's Social Media
Parent/Guardian Name(s)
Your answer
Parent's Cell
Your answer
Parent's E-mail
Your answer
School Presently Attending
Your answer
Grade in Aug. 2017
Gender
Do you have any special needs?
Your answer
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