Youth In Action General Application
Youth In Action is an after school leadership program that is all about social justice through identity work. We want you to know yourself really well and then change that world with that information. This application grants you access to our Core Programming, but if you stay with us beyond a year there are paid opportunities. All of our participants have access to community service opportunities and elective school credit for participation.

If accepted, a parent/guardian will be expected to attend a parent info session and you will be expected to attend our mandatory camping trip that marks the program orientation. The camping trip is August 13-17, please mark your calendar.

Program runs every Wednesday from 4pm-7pm starting in September and running through June. Please make sure you are committed and able to attend the entire year.

Application deadline - Friday, June 8, 2018
Acceptance announcement - Friday, June 22, 2018

Email address *
Name (first and last) *
Your answer
Age *
Your answer
Gender Pronouns (they/them, she/her, he/his +) *
Your answer
Grade (please enter the grade you'll be entering in the fall) *
Your answer
Birthdate *
MM
/
DD
/
YYYY
School Name (that you'll be attending in the fall) *
Your answer
Home Address (Street, City, Zip Code) *
Your answer
Youth Cell Number *
Your answer
Youth Email *
Your answer
Youth Ethnicity/Race (check all that apply) *
Required
Parent/Guardian Name *
Your answer
Parent/Guardian Phone Number *
Your answer
Languages spoken at home *
Your answer
Will you receive a free bus pass? *
How did you hear about YIA? (please be specific) *
Your answer
What else are you involved in? (sports, clubs, religious obligations...) *
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of Youth In Action. Report Abuse - Terms of Service - Additional Terms