Self-Nomination Form: Get Involved in the 2019 Massachusetts Youth Count to Help Address Youth and Young Adult Homelessness + Housing Insecurity!
Please complete this self-nomination form to become a Youth Ambassador with the Massachusetts Commission on Unaccompanied Homeless Youth ("the Commission"), in preparation for the statewide youth/young adult homelessness survey. This year's Massachusetts Youth Count is scheduled for Friday, April 12th - Sunday, May 12th.
Ambassadors help to promote the count to peers, distribute paper copies of the survey, share the online survey link, recruit volunteers, and provide feedback to the Commission and regional teams-- among other tasks/opportunities. Compensation is available for Youth Ambassadors.
Once you complete the form, we will be in touch with more details and invitations.
To read about this year's Youth Count, go to
Thank you for your time and interest! Please share this with other young people who might be interested in participating.
For more details, please contact Kelly Turley at
Are you currently experiencing homelessness?
No, but I recently experienced homelessness
No, but I have experienced homelessness in the past
No, but I currently am experiencing housing instability
No, but I have experienced housing instability in the past
No, I never have experienced homelessness or housing instability
Have you heard of or participated in previous Massachusetts Youth Counts?
If you have participated in previous Massachusetts Youth Counts, what was your experience with it like?
Do you have friends in your community who are experiencing homelessness and under the age of 25?
What do you feel are the BIGGEST challenges youth and young adults experiencing homelessness face?
Which challenge facing youth and young adults experiencing homelessness is the most MISUNDERSTOOD, in your opinion?
If you could do any one thing to help end homelessness in Massachusetts (however big or small), what would it be?
Similarly, what do you think lawmakers and communities can do to end homelessness in Massachusetts?
Have you ever been involved before in advocacy or community organizing? If so, please describe your experience a bit.
A little about you
Name (first and last, if you feel comfortable sharing-- or just first name)
25 or older
City or town where you currently are living/staying
What is the best way for us to contact you? Please include an email address, phone number, and/or other details.
We want to make sure that the Youth Count captures the diverse experiences of youth across Massachusetts. Your answers to the following questions will help with the recruitment of Youth Ambassadors.
We also are working with the Massachusetts Commission on LGBTQ Youth to ensure representation of LGBTQ youth, especially LGBTQ youth of color, in this year's Youth Count.
How would you describe your gender identity? (Check all that apply.)
Transgender, female to male
Transgender, male to female
Which of the following best fits how you think about your sexual orientation? (Check all that apply.)
What is your race/ethnicity? (Check all that apply.)
American Indian/Alaskan Native
Native Hawaiian/Pacific Islander
Middle Eastern/North African
Thank you for your interest in the 2019 Massachusetts Youth Count!
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service