One Step A La Vez serves youth (13-19) from the Santa Clara River Valley
Our mission is to provide a safe environment and prepare informed, empowered youth who are equipped with the tools to lead; cultivate cultural awareness; bridge the gaps of inequality; and advocate for fair, just and healthy individuals and community. 

 If you have any difficulty completing this form, please email us at info@myonestep.org
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Youth's Full Name *
Youth's Age
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Youth's Gender Identity
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Youth's Phone Number  *
Parent / Guardian's Contact Information (Name and Phone Number)
What city does the youth live in?
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Youth's Racial Identity: Select all that Apply (Please note that these are identities as listed under HUD guidelines, but please feel free to expand with more detail or with anything else you'd like us to know/recognize under the "other" option)
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Does youth identify as Hispanic or Latino?
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Youth's Primary Language
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Referring Party's Contact Information  *
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