Youth Eligibility & Household Identification Form
V.I.B.E of my T.R.I.B.E

Pilot Program Entry: October - December, 2025
Youth Selection Date: December 31, 2025
Notification Date: January 1, 2026
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Email *
Youth Information
Full Name *
Date of Birth (Must be at least 12 years old) *
MM
/
DD
/
YYYY
School Name & Grade *
Ex: Benjamin Banneker Middle School - Grade 6
Preferred Name/Nickname
T-Shirt Size
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