BAE Breaker Chapter Lead Registration
Thank you for expressing interest in starting a SafeBAE Chapter in your school or community!
Steps for becoming a BAE Breaker Chapter Lead:
1. Review the criteria here:
2. Complete this form.
3. Schedule a meeting with the Youth Outreach Director:
4. After your meeting, download the SafeBAE app and check out our materials!

Last Name: *
First Name *
Personal Email address (not school) *
Age: *
Grade *
Cell Phone Number: *
Full name of school: *
Name of faculty advisor (you can choose later, if needed)
Email address of faculty advisor
pronouns: *
race: *
State of residence? *
What is your street mailing address? *
Social Media Handles (Insta, twitter, snap, tik tok, FB, etc)
Have you been a BAE Breaker before? *
How did you hear about SafeBAE? *
Why do you want to start a SafeBAE Chapter (or continue) at your school? *
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