Help us create a youth directed community program!

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First Name / Nombre

Last Name / Apellido

Email Address / Correo Electrónico

Phone Number / Número de Teléfono

Age / Edad *

What excites you about a youth leadership program? / ¿Qué te emociona de un programa de liderazgo juvenil?

What do you see as the biggest challenges for youth in your community today? / ¿Cuáles consideras que son los mayores desafíos para los jóvenes en tu comunidad hoy en día?

How would you like to get involved? / ¿Cómo te gustaría participar?

Are you currently part of any youth group, school organization, or community initiative? / ¿Eres parte de algún grupo juvenil, organización escolar o iniciativa comunitaria? (please specify) / Sí (por favor especifica)

Preferred Contact Method / Método de Contacto Preferido

Additional Comments or Questions / Comentarios Adicionales o Pregunta

Share what you’d like to learn, how you want to make an impact, or what you expect from the program.Comparte qué te gustaría aprender, cómo quieres impactar o qué esperas del programa.

Thank you!

Would you like to receive updates about this program and future events?

¡Dale click AQUÍ para recibir nuestras noticias y actualizaciones!

Click HERE to receive our news and updates!

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