Youth In Action General Application
Youth In Action is an after-school leadership program that focuses on social justice through identity work and bringing our truths. We want you to know yourself really well and then change that world with that information. This application grants you access to our Core Programming, but if you stay with us beyond a year there are paid opportunities. All of our participants have access to community service opportunities, elective school credit for participation and field trips.

If accepted, a parent/guardian will be expected to attend a parent info session and youth to participate in our orientation activities in the summer.

Program runs every Wednesday from 4pm-7pm starting in September and running through May. Please make sure you are committed and able to attend the entire year.

** Please note: Youth In Action is a program for High School students. The program is open to youth who attend school in the state of Rhode Island and can attend programming which is located on Broad St. in Providence.  If you have any questions, please contact Olubunmi at 401-751-4264.

***If you are completing this form after Nov 1st, your app will be reviewed for the next year's cycle.

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Email *
Name (first and last) *
Age *
Gender Pronouns (they/them, she/her, he/his +) *
Grade (please enter the grade you'll be entering in the fall) *
Birthdate *
MM
/
DD
/
YYYY
School Name (that you'll be attending in the fall) *
Home Address (Street, City, Zip Code) *
Youth Cell Number *
Youth Email *
Youth Ethnicity/Race (check all that apply) *
Required
Parent/Guardian Name *
Parent/Guardian Phone Number *
Languages spoken at home *
Will you receive a free bus pass? *
How did you hear about YIA? (please be specific)
What else are you involved in? (sports, clubs, religious obligations...)
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