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 *
First Name *
Gender Pronouns *
Economic Class
Do you identify as LGBTQIA+?
(This is used for demographic tracking and will not be attached to your name)
Clear selection
Birthday *
Phone Number
Current Location *
Job/Affiliated Organizations/Clubs
Mailing Address
Anything else you want us to know about you?
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy