Youth ACT Application - Fall 2018
Youth ACT is an Audubon Society of Portland training program for youth that fosters conservation and advocacy skills, provides community organizing tools, and deepens environmental policy education.

This application is divided into two parts - applicant information and supplemental questions.
Application deadline is September 22, 2018

Email address *
Applicant Information
Full Name *
Your answer
Alternate Name
Your answer
Home Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Home Phone # *
Your answer
Personal Cell Phone # *
Your answer
Receive text messages on personal cell phone? *
What is the best way of getting in contact with you? (Check all that apply.) *
Required
Date of birth *
MM
/
DD
/
YYYY
What gender pronouns do you prefer? *
Required
Are you attending school? *
Current School Name and Grade Level *
Your answer
Do you speak a language other than English at home? *
If yes, which language?
Your answer
Are you involved with any organizations or programs that focus on social justice, activism, community organizing, animal advocacy, etc? *
If so, which organization(s) or program(s)?
Your answer
The Youth ACT training sessions will start and end at the Portland Audubon Sanctuary near Forest Park and at times will take field trips to different locations in Portland (in our 15 passenger van). We are happy to provide transportation assistance to the Portland Audubon Sanctuary. Would you need such assistance? *
Below are the program dates. Attendance to many or all program dates is required. Please indicate which dates you'll be able to commit to: *
Required
We will often be providing lunches. Please list any dietary restrictions that we should be aware of.
Your answer
Legal Guardian Information
Name of Legal Guardian *
Your answer
Guardian contact phone number *
Your answer
Guardian email address *
Your answer
Name of second legal guardian
Your answer
Second guardian contact phone number
Your answer
Second guardian email address
Your answer
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