STAY Project Membership Form
This form is created to get updated information from current STAY members and for new STAY members to sign up!

The only criteria to becoming a STAY member is:
1. That you are between 14-30 years old.
2. You're a young person from Central Appalachia including Eastern Kentucky, Southwestern Virginia, Eastern Tennessee, West Virginia, and Western North Carolina.

Email address *
Last Name *
Your answer
First Name *
Your answer
Gender Pronouns *
Your answer
Race/Ethnicity
Your answer
Economic Class
Your answer
Do you identify as LGBTQIA+?
(This is used for demographic tracking and will not be attached to your name)
Birthday *
MM
/
DD
/
YYYY
Phone Number
Your answer
Current Location *
Your answer
Home
Your answer
Job/Affiliated Organizations/Clubs
Your answer
Mailing Address
Your answer
Anything else you want us to know about you?
Your answer
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