ESYDA Kicking Life into Gear Program: Registration Form (2021)
Welcome and thank you for your interest!  

ESYDA Kicking Life into Gear Program is a structured program designed to support middle and high school youth gain positive socioemotional skills and values through education, athletics, promotion, and experiential learning that are necessary for a successful transition into adulthood.  

ESYDA hopes individuals who participate in this program will gain

Value for overall wellness and physical activity
Increased ability to communicate effectively (verbal, writing, non-verbal)
Knowledge on specific college preparatory topics (SAT, ACT, college application, etc.)
Personal financial planning, management, and budgeting skills
Build confidence and communicate effectively to lead
Ability to integrate and work with others in society or place of work  
Awareness of educational requirements for higher learning

Virtual sessions begin Tuesday, June 1, 2021 and are hosted on Mondays & Thursdays from 5pm to 6pm. Sessions are available to Montgomery County middle and high school residents free of charge.

Please visit to register for ESYDA’s in-person recreational soccer: https://www.esyda.org/fall-season-starts-in-august/ 

Questions? Please contact operations@esyda.org 


Funded in part by The Montgomery County Collaboration Council for Children, Youth and Families and Elite Soccer Youth Development Academy, Inc.

Partners & Sponsors: YAA Enterprise, LLC; The Global Health Institute of Innovation and Leadership, Inc.; Omotunde Sowole-West- Consultant, Vicente Health Consulting, LLC
Sign in to Google to save your progress. Learn more
First Name *
Middle Name
Last Name *
What is your Birthday? *
(Month/Date/Year- Example 04/21/2002)
MM
/
DD
/
YYYY
Full Home Address *
Please remember to include your city and postal code in order to determine your eligibility.
Email Address *
We will use this address to communicate with you about the program and send friendly reminders.
Preferred Phone Number *
Parent/Guardian Full Name *
Parent/Guardian Phone Number *
Parent/Guardian Email Address *
Do you have access to use a computer for the program? *
Do you have access to use the internet? *
If you have a physical or mental impairment that may substantially limit you from participating and completing online activities, please describe what accommodations are needed to support you. If none, please state "none".
Do you need an interpreter/translator during this program? If yes, please specify.
Which gender do you identify most with? *
Are you Hispanic or Latino? *
What is your race? (Select one or more responses.) *
Required
Was your parent/guardian or you born in another country other than the United States? If yes, please indicate the countries below. *
This information is used to create culturally appropriate resources and identify what sub-populations participate in the program.
What grade will you (the student) be entering in Fall 2021? *
Name of your current school *
When you are physically at school, do you get breakfast or lunch for _____________ *
Are you currently attending, will you attend, or did you attend any Montgomery County Public Schools Summer School programming during summer 2021? *
On your last report card, how would you describe your grades in school? *
Which of the following topics have you taken a class, workshop, or training for? *
Please mark all that apply.
Required
Which virtual/online sessions are you registering for? *
Session links will be provided the day of the session
Required
How would you describe your knowledge around getting into college? *
How would you describe your skills in getting a job or starting a career? *
How would you describe your  leadership skills? *
Within the past year, have you participated in any civic engagement activities?
Civic engagement involves “working to make a difference in the civic life of one’s community and developing the combination of knowledge, skills, values and motivation to make that difference. It means promoting the quality of life in a community, through both political and non-political processes.” Civic engagement includes both paid and unpaid forms of political activism, environmentalism, and community and national service. Volunteering, national service, and service-learning are all forms of civic engagement.
Clear selection
How would you describe your ability to be fiscally responsible? *
"Fiscally responsible requires you to set goals and make an action plan for yourself on how to save and use money. Being accountable for your finances requires determination."
Do you have a resume? *
Do you have a job? *
How would you describe your professionalism skills? *
For example, time management, communication, workplace professional etiquette, interviewing, etc.
Have you ever participated in a financial workshop? *
Are you interested in volunteer work to gain work experience for your resume? *
Additional information about volunteer opportunities will be made available when you successfully complete the program.
What other topics are you interested in learning about in a workshop or program?
Any questions you would like to ask your facilitators about college preparation, preparing for a job or career, leadership, civic engagement or financial responsibility?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of YAA Enterprise. Report Abuse
Google Forms