Youth Engagement Application

You can write your answers to these question through this page, or on zoom with the Youth Engagement and Empowerment Coordinator. If you have any questions, or you need help with this application please contact:

Rachel Shandler, Youth Engagement and Empowerment Coordinator

Email: rshandler@spanadvocacy.org
Phone: 215-550-1340

1.Name:

2.Age:

3.Email:

4.Phone number

5.What state do you live in?

6.What is your race/ethnicity?

Indigenous, Native American, American Indian, or Alaskan Native

Asian / Middle Eastern

Black or African American

White / Caucasian

Pacific Islander or Native Hawaiian

I don't want to answer

Multiple ethnicity / Other (please specify)

*7.Are you Latinx or Hispanic?(Required.)

Yes

I do not know what this question means.

Prefer not to say

*8.What is your Preferred Language(Required.)

English

Spanish

Vietnamese

Korean

Arabic

Guajarati

Hindi

Russian

French/French Creole

Chinese

Somali

American Sign Language (ASL)

Other (please specify)

9.Are you a member of the LGBTQIA community?

Yes

I don't know

Prefer not to say

10.Do you have an intellectual and/or developmental disability?

Yes

I don't know

I prefer not to say

11.If you have a disability, please describe it?

12.What disability accommodations do you need to participate in an online meeting?

13.What opportunities are you interested in? Check all that apply

Website Youth Advisor

Youth Steering Committee Member

Toolkit Youth Advisor

Youth Development Initiative (YDI) Group Mentor

Youth Development Initiative YDI (Learning Opportunity for youth 12-17)

*14.If you are a youth, or a parent/guardian of a youth who is under 18, (minor) we must have a parent or guardians signature. Please type the the name and email of the parent or guardian below(Required.)

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