STAY Project Membership Form

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This form is created to get updated information from current STAY & Black Appalachian Young & Rising members and for new STAY & BAYR 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, Western North Carolina, and Northern Alabama.

Black Appalchian Young & Rising (BAYR) is a program of the STAY Project that is for Black youth between the ages of 14-30 living in the locations we mentioned above.

Email *

Last Name *

First Name *

Gender Pronouns *

Race/Ethnicity

Economic Class

Poor/Working Class

Middle Class

Middle/Upper Class

Wealthy

Clear selection

Do you identify as LGBTQIA+?

(This is used for demographic tracking and will not be attached to your name)

Yes

I'm not sure

I would rather not say

Clear selection

Birthday *

YYYY

Phone Number

Current Location *

Where are you from?

Job/Affiliated Organizations/Clubs

Mailing Address *

This is so we can send you cute STAY/BAYR Swag <3

Anything else you want us to know about you?

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This form was created inside of Stay Together Appalachian Youth Project.

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