Youth Empowerment Alliance: Get to Know You
Thank you for your interest in ending dating abuse in the Lehigh Valley! Please complete all sections marked with a red asterisk (required) and feel free to add your thoughts to the optional sections as well. If you have any accessibility needs that may prevent you from completing this form, or have any questions, please call Lisa at 610-797-0530 x308 or email her at lisaw@turningpointlv.org. Thank you!
Sign in to Google to save your progress. Learn more
Email *
Phone number *
What name should we call you by? *
What pronouns do you use? (such as he/she/they/ze, etc.) *
What school do you attend? *
What is the last grade you completed? *
What experiences and/or unique perspectives do you think you could bring to the table? *
Why do you think programs like this are important?
What ways do you hope to grow by participating in this program?
How comfortable are you working in a group and with a close team of people? *
Not comfortable
Totally comfortable
Are you able to commit to a 2 hour meeting, once per month? *
If you answered not sure yet, can you explain a bit more? (If you answered yes/no to the previous question, please write N/A in this space) *
The following is demographic information. This information will be kept confidential; it is our intent to only use this information to help inform the make-up of the Youth Empowerment Alliance - in either this round of member selection or in future rounds. The personally identifiable information shared in this section will not be shared outside of Turning Point of Lehigh Valley. *
Required
How would you describe your race/ethnicity?
How would you describe your gender?
How would you describe your sexual orientation?
What is the zip code of the place you're staying now or most recently stayed? *
How did you hear about this opportunity?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms