Youth In Action General Application
Youth In Action is an after-school leadership program that focuses on social justice through identity work and bringing our truths. 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, elective school credit for participation and field trips.

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 overnight camping trip/Wilderness Retreat is August 12-16, 2019 please mark your calendars!

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

Application deadline - Friday, June 21, 2019
Acceptance announcement - Friday, June 28, 2019
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
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