North Richmond Youth Listening Session Interest Form [NOT A SURVEY] // Sesiones de escucha para los jóvenes en North Richmond [ESTA FORMA NO ES ENCUESTRA]

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Thank you for your interest in applying to join our North Richmond Youth Listening Sessions. (This is NOT the survey.) This interest form is for youth who live and/or have lived experience in North Richmond.

By voicing your opinions in the youth listening sessions, you will INFORM FUTURE DEVELOPMENT PLANS such as resources, services, and programs that impact the lives of children and youth in North Richmond.

WHAT DO I GET FOR PARTICIPATING? --> !!! You will receive a $15 Target Gift Card !!!

WHERE IS THE LOCATION OF THE SESSION? --> The session will be held on ZOOM. You will receive the zoom link AND a google calendar invite in a follow up email.

WHEN IS THE SESSION HELD? --> It will be determined based on the collective responses to one of the questions below.

After finishing this form, you will receive an email from Healthy Richmond - Dante Miguel.

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Gracias por su interés en aplicando para participar en nuestro North Richmond Youth Listening sessions. (Esta forma no es encuestra!)

Esta forma es para jóvenes que viven o han vivido o tenido experiencia en North Richmond.

Dando su opinión durante los reuniones de jóvenes, informará planes futuros de recursos, servicios y programas que afectan los niños y jovenes en North Richmond.

QUE RECIBO PARA PARTICIPAR? Tú recibirías una tarjeta de Target por $15 !!!

DONDE ESTA EL LUGAR DE LAS SESIONES? La sesión sera sobre ZOOM. Recibirá el enlace de zoom Y una invitación del calendario de Google en un correo electrónico de seguimiento.

CUANDO ES LA SESIONS? Se determinará en función de las respuestas colectivas a una de las preguntas siguientes.

Depues que terminar esta forma va a recibir un correo electrónico de Healthy Richmond; Dante Miguel.

First and Last Name // Nombre y Apellido *

Pronouns(s) *

Age // Edad *

Phone Number *

Email *

[OPTIONAL] - Social Media Contact Information

What is the best way to reach you? // Cual es la mejor manera de comunicarnos con usted? *

Phone

Social Media

All of the Above

Other:

What is your race/ethnicity? // Cual es su raza/origen etnico? *

African/Black/Caribbean

Asian American & Pacific Island

Asian/South East Asian

Native American/Indigenous

Mixed

Chicanx/Latinx/Hispanic

White/Caucasian

Other:

Please select or enter the school you are enrolled in // Escoge o ingrese la escuela en la que esta inscrito *

Richmond High School

Kennedy High School

De Anza High School

Middle College High School

Sylvester Greenwood Academy

Making Waves Academy

Richmond College Prep

Summit Public Schools K2

Leadership Public Schools

John Henry High School

Crespi Middle School

DeJean Middle School

Helms Middle School

Contra Costa Community College

Not in School

Other:

Which session will you be available to attend? // Que sesion podras asistir? *

Mondays

Tuesdays

Wednesdays

Thursdays

Fridays

4:00pm - 4:30pm

4:30pm - 5:00pm

5:00pm - 5:30pm

5:30pm - 6:00pm

If the following times above do not work for you, when are you available? *

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