Youth Health and Justice Series Application

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Welcome to the application to attend the Youth Health and Justice Summer Series in Montpelier. For more information about attending this series, please visit: https://docs.google.com/document/d/1thHiBuV7O3rCVexNAcSchfEgtyc123_2m94A7paS0L0/edit#heading=h.ybnllkz4tdir.

Due to covid precautions, we are only able to allow 12 youth to attend this in-person series. We're hoping to offer more opportunities like this in the future.

Please fill out the following questions and we will get back in touch soon.

Email *

What is your name? *

What pronouns do you use? *

What is your phone number? *

What school do you attend? If you no longer attend school, what school did you last attend? *

What town do you live in? *

Have you read the information sheet on the Summer Series? *

Yes

What excites you about participating in this education and dialogue series? *

What do you hope to learn? *

What is your biggest concern about your school/community that you'd like to work to change? *

Would you have an interest in becoming a peer educator around some of the skills and topics offered in this series and teaching them to middle school students in the future? *

Yes

Maybe

Are you willing to follow covid precautions and wear a mask and maintain physical distancing protocols while attending the series? (We can provide a mask if needed) *

Yes

Would you be interested in continuing to engage with this subject matter during the school year? If so, would you prefer an in-person format or over zoom?

YES - in-person

YES - over zoom

YES - no preference on the format

Maybe

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Are you able to attend all the classes in the series? *

Yes

Maybe

What else do you want to share about yourself to help us understand you and your interest in this education and dialogue series? *

Would you like to be added to our email list to receive information on future offerings from Central Vermont New Directions Coalition? *

Yes

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