Circles of Change for Youth: Community Agency Registration
Circles of Change for Youth facilitates dialogue circles for community agencies serving youth, ages 12-17. These small groups are designed to allow participants to consider all points of view, discover common ground, and develop ideas and networks that are necessary for taking action. Groups meet for 90 minutes, once a week, for 4-weeks, with the goal of creating an action plan to be carried out by your agency.

If you are interested in having your community agency participate in this experience, please complete the requested information below. You will receive an email with follow up information within 3 business days. If you have questions or need additional information, please contact Jodi Hubbard or Audrey Robinson at: circlesofchangeec@gmail.com

Email address *
Agency Information
Please provide the requested information regarding your agency.
Agency Name *
Your answer
Contact Person *
Your answer
Telephone Number *
Your answer
Mailing Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Participant Information
Please provide the number of youth and youth leaders that will be participating in the dialogue circles so that we can plan for the number of facilitators needed (2 facilitators for each group of 10-15 participants). If you do not have an exact number, then please give us your best guess. We will finalize numbers with you once we sign the contract for service.
Number of Youth Participating *
Your answer
Number of Youth Leaders Participating *
Your answer
A copy of your responses will be emailed to the address you provided.
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