Student Policy/Agreement Form

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Student Policy/Agreement Form

Parents or guardians of the student are required to complete the application for participation form below. YOUmedia staff will connect with the listed school counselor, parent or guardian, and the student to ensure all information is accurate. Your student will meet with YOUmedia staff during the orientation process, when they are accepted into the program. Thank you for your interest in YOUmedia.

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* Indicates required question

Student Name *

Your answer

Parent/Guardian Name *

Your answer

Parent/Guardian Phone Number *

Your answer

Parent/Guardian Email

Your answer

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