Interest Form

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Interest Form

Thank you for your interest in our new program! If you have any questions about this form or the program in general please reach out to our program facilitator, Kaylyn, at kbettencourt@njprevent.com.

This form will help us get some information on how and when to begin, and make sure that our group is a good fit for you!

This group is run through Prevention Resources, and the Positive YOUth initiative, and is geared towards youth ages 14 through 18, who identify as part of the LGBTQ+ community. Our goal is to come together as a community, meet others who may be sharing some of the experiences that are unique to this community, and to socialize, learn, and collaborate. For and comments, questions or concerns, please reach out to Kaylyn at kbettencourt@njprevent.com.

Before we get started, please tell us your age: *

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