Bayview Hunters Point Youth Environmental Justice Air Quality Leadership Academy Application

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Requirements:

1. You must be between the ages of 13-18 years old
2. You must live in 94124 Zip Code
3. You must be able to attend all class sessions
4. You must be able to commit to 40 hours of outreach
5. You must have access to wifi/data and a device
(if this is a problem, email dalila@greenaction.org, 650-630-3718 or agustin@greenaction.org, 805-403-4218)

Email *

Name (First and Last) *

Address *

Phone Number *

Age *

Date of Birth *

YYYY

Do you have accessibility to a smartphone, tablet, or computer? *

Yes

Do you have internet access or mobile data? *

Yes

Last School Attended *

Highest Grade Completed *

How long have you lived in Bayview Hunters Point? *

What issues have you witnessed while living in Bayview Hunters Point? *

Have you ever been involved in any form of activism addressing the issues you mentioned above? *

Why do you want to participate in this Leadership Academy? *

Will you be able to commit to and attend all of the class sessions? If not, what dates will you miss? *

July 8th from 10AM-12PM

July 15th from 5:30PM-7:30PM

July 22nd from 10AM-12PM

July 29th from 10AM-12PM

August 5th from 10AM- 12PM

August 12th 10AM- 12PM

End of August- (Last session date TBD)

I can commit to an attend all of the dates mentioned above

Required

Do you have any other time commitments (i.e. babysitting, clubs, sports, jobs) that may prevent you from attending? *

What are 3 facts about yourself? You can get as personal as you want or not at all, whatever is comfortable for you to share. *

Send me a copy of my responses.

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