YLSC 2017 Student Registration
Young Leaders, Strong City's 4th Annual Racial Justice Youth Summit will be held:

November 11th, 2017
9 am - 5pm.
CWA Building 1408 N Washington Ave, Ste 300 Dallas, TX

The day will include food, interactive workshops and meaningful, constructive discussions on race, racial identities, racism and equity. Submission Deadline: Friday, October 27

Questions? Please contact us at ylscdallas@gmail.com or sara.mokuria@utdallas.edu

Email address *
First Name *
Your answer
Last Name *
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High School *
Your answer
Age *
Your answer
Grade *
Parent or Guardian's First Name *
Your answer
Parent or Guardian's Email *
Your answer
Parent or Guardian's Last Name *
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Gender Identity
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Languages spoken [language, skill level ]
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Do you require an ASL interpreter?
Please describe your racial and/or ethnic identity. *
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What is your favorite song? *
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Phone number *
Your answer
If nominated, what is the name and role of the person who nominated you. (If not applicable, type N/A *
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Are you a returning student? *
What size t-shirt would you like?
Do you identify as a member of the LGBTQIA community?
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