Teen PeaceBuilders Leadership Summit
Use this form to submit your application for the Teen PeaceBuilders Leadership Summit on July 15-19, 2019. We only have space for 12 participants and selections will be made based on information from applications & recommendations with an intent to form clusters of students from a few different schools.

Applications must be submitted by June 7th, 2019

First & Last Name *
Your answer
Address (street, city) *
Your answer
Phone Number *
Your answer
Email *
Your answer
School Info
Please answer School and Grade for the upcoming school year (not current). Activities and Clubs can be for current and past school years.
School (2019-2020) *
Your answer
Grade (2019-2020) *
Activities, Clubs, etc. (school-based or other programs)
Your answer
Other Info
Just general background info...
Race/Ethnicity
Your answer
Gender
Your answer
Do you have any special dietary needs? If yes, please provide details
Your answer
Will you need transportation? If yes, make sure your address above is correct.
Your answer
How did you find out about this program?
Your answer
Short Answer Response
Your moment to tell us why you should be selected to participate
Why are you interested in being part of the Teen PeaceBuilders Leadership Summit? *
Your answer
Would you be willing to work with Triad Restorative Justice to use what you learn during the Leadership Summit with your school or community in the upcoming school year? *
Your answer
Recommendation
All applicants must include a short letter of recommendation from an adult at your school, place of worship, sports activity or other community organization. This can be an informal recommendation - it does not need to be fancy or formal. These may be emailed to hello@triadrj.org. Please make sure they include their name and contact info.
Who will be submitting your recommendation? Please provide their name and their connection to you. *
Your answer
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