Young Mamas Leadership Summer 2021 Application

Do you require language interpretation? / ¿Necesita interpretación de idiomas? / Èske ou bezwen entèpretasyon langaj? *
Full Name / Nombre Completo / Non Konplè *
What are your gender pronouns?/ Cuales son sus pronombres? / Ki sa ki pwonon sèks ou a? *
(Gender pronouns are the pronouns that people choose to use for references to themselves. For example, if Xena's preferred pronouns are she, her, and hers, you could say, "Xena ate her food because she was hungry." Some gender pronouns are neutral (them, they, theirs), some are not (she, he), and some have been created as an alternative to or rejection of the gender binary. Everyone has the right to use the gender pronouns that match their personal identity. These pronouns may or may not match their gender expression-how the person dresses, behaves, or looks). More info here: https://bit.ly/3h9qJI2
Email / correo electrónico / Imèl *
Phone Number / Número de Telefono / Nimewo telefòn *
Home Address / Dirección / Adrès lakay *
Mailing Address (if not the same as home address) *
Which of the following best describes you? / Cual de estos lx describen mejor?/ Kilès nan bagay sa yo ki pi byen dekri ou? *
(This is for the purpose of recording demographics)
Required
Age / Edad / Laj *
How many days can you commit to attending YMLI Summer 2021? / Cuantos dias se puede comprometer para attender el instituto en el verano 2021? / Konbyen jou ou ka angaje nan ale nan YMLI pandan ete 2021? *
The program will be from August 9th-August 13th, Everyday from 12pm-4pm. If you cannot attend the full program please explain why in the option labeled other.
Why do you want to participate in the Young Mamas Leadership Institute Summer 2021 Program? / Porque quiere participar en el Instituto de Liderazgo de Mamas Jovenes del Verano del 2021? / Poukisa ou vle patisipe nan Program Young Mamas Leadership Institute pandan ete 2021 la? *
(4-5 Sentences)
Where did you give birth? / Donde diste parto? / Ki kote ou te akouche? *
How old are your children? / Cuantos años tienen tus hijxs? / Ki laj pitit ou yo? *
How would you describe your birth experience(s)? / Como decribe su experiencia de parto? / Ki jan ou ta dekri eksperyans nesans ou (yo)? *
What is your learning style? / Cual es su estilo de aprendisaje? / Ki style aprantisaj ou? *
Captionless Image
Required
Do you consider yourself to be introverted, extroverted or somewhere in the middle? / Considera ser introvertidx, extrovertidx, o en algun lugar en medio? / Èske ou konsidere tèt ou kòm entrovèrti, èkstravèrti oswa yon kote nan mitan an? *
More info here: https://bit.ly/2U75xuy
Do you require childcare while attending YMLI Summer 2021? If so, for how many children? / Usted requiere cuidado de niñxs mientras participa en YMLI entrenamiento? / Èske ou bezwen gadri pandan w ap patisipe nan YMLI pandan ete 2021? Si se konsa, pou konbyen timoun? *
Do you have any dietary restrictions? / Tiene restriciones dietarias? / Èske w gen nenpòt restriksyon dyetetik? *
Do you have any allergies? / Tiene algunas alergias? / Èske ou gen nenpòt alèji? *
What is your T-shirt size? / Cual es su tamaño camiseta? / Ki gwosè mayo ou? *
Do you need transportation support to get to YMLI Summer 2021? If so, please explain further in the box labeled other. / Necesita transportacion para llegar al entrnamiento? Si es asi porfavor explique mas en la opcion "other"/ Èske ou bezwen sipò transpò pou li ale nan YMLI pandan ete 2021? Si se konsa, tanpri eksplike plis nan bwat ki make "other". *
Required
What do you like to do for fun? / Que le gusta hacer para divertirse? / Ki sa ou renmen fè pou plezi? *
What do you like to do to relax? / Que le gusta hacer para relajarse? / Ki sa ou renmen fè yo detann? *
What would make this institute more engaging for you? / Que haría este instituto mas interesante para usted? / Ki sa ki ta fè enstiti sa a plis angaje pou ou? *
Do we have your permission to photograph and post any media of you related to YMLI Summer 2021? / Tenemos permiso para tomar fotos y ponerlas en medios sociales? / Èske nou gen pèmisyon ou nan foto ak afiche nenpòt medya nan ou ki gen rapò ak YMLI pandan ete 2021? *
Is there anything else you would like to share? / Hay algo más que quisieras compartir? / Èske gen lòt bagay ou ta renmen pataje?
Do you give the Southern Birth Justice Network permission to use your email and phone number to contact you for future programming opportunities? / Le das permiso a Southern Birth Justice Network permiso para usar el correo electrónico y número de teléfono para contactarte con para futuros programas? / Eske ou bay Southern Birth Justice Network la pèmisyon pou itilize imèl ou ak nimewo telefòn ou pou kontakte ou pou opòtinite pou pwogram nan lavni? *
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