Peers Building Justice Youth Organizer Application 2016-17
General Information, please fill out your contact information, even if you can't complete the rest of the application
Name *
First and last. Preferred names are OK.
Your answer
Phone Number *
If you have a personal cell phone, please use that number. If you don't, please put the most likely way of reaching you
Your answer
Type of phone *
Email *
Please put the email account you check most frequently
Your answer
Best and fastest way to reach you *
Home Address
If not applicable, you can leave this one blank
Your answer
School *
Which high school are you entering in 2016 or currently enrolled in?
Your answer
Birthdate *
MM
/
DD
/
YYYY
Ethnicity
Optional
Your answer
Sexual Orientation
Optional
Your answer
Gender Identity
Optional
Your answer
Year in School *
If you are starting 9th grade in Fall of 2016 pick 9
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