Somerville Youth Network Common Registration

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Haitian Creole ( Kreyòl)

Ki non patisipan an? (non ak siyati) *

Ki enfòmasyon kontak paran oswa gadyen legal patisipan yo? (telefòn selilè, imèl) *

Ki laj patisipan an genyen? *

Èske w apwouve patisipan an antre nan espas sa lè gen yon granmoun? *

Dojo @ SomerNova

Armory

South Street Farm

Required

Èske w apwouve pitit ou a pou l patisipe nan pwogram gratis yo

(diferan pwogram gratis…)

Groundwork Green Team Bike Division

Somerville Robotics League

YouthStream

Creative by Nature

Parkour

Franklin-Cumming GreenTech Bootcamp

All of the above

Required

Èske w apwouve pitit ou a sèvi ak yon bon (koupon) pou l vwayaje nan yon Green Cab (taksi) pou l ale lakay li, Dojo @ Somernova, pou l ale nan Mystic Learning Center a ou Lekòl (Somerville High School oswa nan West Somerville Neighborhood School)? *

Yes

n/a

Kesyon sa yo gen rapò demografik obligatwa nou yo. Nou itilize enfòmasyon sa yo sèlman pou ede nou jwenn finansman pou pwogram gratis nan lavni. *

Gason

Non binè

Mwen pito dekri nan pwochen kesyon an

Mwen pito pa di

Required

Tanpri dekri sèks patisipan an la.

Èske patisipan an se panyòl oswa latino? *

Non

Mwen pito pa di

Ki ras patisipan ye? Tcheke tout sa ki aplike. *

Endyen Ameriken oswa natif natal Alaska

Azyatik

Nwa oswa Afriken Ameriken

Mwayen Oryan oswa Afrik di Nò

Natifnatal Awayi

Blan

Mwen pito dekri pwòp tèt mwen nan pwochen kesyon an

Mwen pito pa di

Required

Tanpri dekri tèt ou (Ki ras patisipan an.)

Konbyen lajan (kòb) ou antre nan kay la nan yon ane? *

Less than $10,000

$10,000 - $24,999

$25,000 - $49,999

$50,000 - $74,999

$75,000 - $99,999

$100,000 - $149,999

$150,000 - $199,999

$200,000 or more

Prefer not to say

Sa enkli tèt ou, konbyen moun ki nan kay ou a (pa egzanp, manm fanmi ak/oswa moun ki soutni revni kay la)? *

Prefer not to say

Nan ki zòn ou rete? *

Ward 1: Assembly Square, Cobble Hill, East Somerville, Foss Park, Inner Belt, North Point, Mystic River

Ward 2: Boynton Yards, Brickbottom, Duck Village, Union Square

Ward 3: Central Hill, Prospect Hill, Spring Hill

Ward 4: Gilman Square, Temple Square, Ten Hills, Winter Hill

Ward 5: Ball Square, Magoun Square, Porter Square

Ward 6: Davis Square, Powder House Square, Tufts, West Somerville

Ward 7: Clarendon Hill, Hillside, Teele Square

I live outside of Somerville, in city/town (fill in next question)

Mwen abite andeyò Somerville, nan vil_____:

Ki lang ou pale lakay ou? *

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