DOVES Network Youth Ambassador and/or Peer Support Group Interest Form
Please take a moment to complete the below inquiry form. A member of our team will contact you within 24-48 hours. Thank you!
Date of Contact
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Parent or Teen Submitting? *
Teen First Name, Last Name *
Has the teen been exposed to and/or experienced domestic violence? *
Program of Interest *
Required
Teen Contact Email *
Teen Contact Number *
Date of Birth *
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Zip Code *
School District
Teen Preferred Method of Contact *
Does the youth have technology to access webinar meetings? *
Is the teen able to attend peer sessions Wednesday's @ 4pm (Arizona) / 7pm (EST)? *
Is the teen able to attend peer sessions Saturday's @ 10am (Arizona) / 1pm (EST)? *
If 'no' was selected to any of the days and times above, please list the availability that is preferred. *Note - this does not confirm we will be able to accommodate, but will be taken into consideration.*
Parent / Guardian Name
Parent/Guardian Email Address *
Parent/Guardian Phone Number *
Parent Preferred Method of Contact *
What interests you about signing up for either DOVES Network Peer Circles? *
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