Civics & Conservation Summit Application 2019
Please visit www.akcenter.org/ayea/ to learn more about the program before applying.
-------------------------------------------------------------------------------------

This is a 3 page application for the Civics & Conservation Summit with Alaska Youth for Environmental Action. This first page is short answers, the second page is paragraph answers, the last page is check-boxes.

The Summit will be Monday, March 4th-9th (Monday, March 4th and Saturday, March 9th will be travel days). The Summit begins at 9 am on Tues, March 5th and ends in the evening on Friday, March 9th.

If you attended a previous Civics & Conservation Summit please apply to be TRAINER, that application is here: https://goo.gl/forms/LHCEEbI1UjxCCexk2

Deadline to apply: SUNDAY, JANUARY 27th. Early applications are appreciated.

Contact Margi if you have any problems or questions, 907-347-6201, ayea@akcenter.org.

Thanks for your interest!

Email address *
Legal First and Last Name *
Your answer
Name you preferred to be called
if different than your legal name
Your answer
Mailing Address *
Your answer
City/ Village *
Your answer
Zip Code *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Grade in School *
Home Phone *
907-XXX-XXXX
Your answer
Cell Phone *
if you don't have a cell phone, write None
Your answer
Best phone to reach you: *
We will call you to talk about your application and acceptance
Gender *
Race/ Ethnicity
optional
Parents'/ Guardians' Names *
If you are an emancipated minor, or your legal guardian is unavailable, put "n/a" in these section.
Your answer
Parents'/ Guardians' phone numbers *
Your answer
Parents'/ Guardians' email address *
Your answer
Best way to reach your Parents'/Guardians:
We need to talk to your guardians in order for you to attend the Summit
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of The Alaska Center. Report Abuse - Terms of Service