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Request to Connect/
Solicitud Para Informacion
This online form is to request more information or begin an application on any of our BSYC programs
Esta forma en linea es para solicitar mas informacion o iniciar la aplicacion para nuestros programas de BSYC
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* Indicates required question
Your Full Name/
Su Nombre Completo
*
Your answer
Today's Date
*
MM
/
DD
/
YYYY
Your Phone Number/
Su numero de Telefono
*
Your answer
Your Role/
Su Rol
(ex: Parent, student, Director of..., Coord. of... etc)
*
Your answer
Your Email/
Su Email
*
Your answer
Your Preferred Language/
Su lenguaje
*
English
Español
Bilingual / English-Spanish
Other:
Required
Your need/
Su necesidad
*
More information on your services/ Mas informacion sobre los servicios
Apply BSYC membership/ Aplicar para un programa
Collaborate with BSYC
Donate/ Quiero hacer una donacion
Work at BSYC/ Quiero trabajar en BSYC
Volunteer/ Quiero voluntarizarme
Other:
Required
Program of Interest/
Programa de Interes
*
After School Program School Year 2023-24/ Programa Despues de Escuela año escolar 2023-24
BSYC Employment Opportunities/ Opportunidades de Empleo
BSYC Volunteer Opportunities/ Opportunidades de ser voluntarios
Fired Up Fridays
Teen Peer Ministry
Spirit Day
Other:
Required
Neighborhood you live or represent
La comunidad en la que usted vive o representa
*
North Lawndale
La Villita (Little Village)
Pilsen
Cisero
Other:
Required
How did you learn about us? (Check all that apply)
Como supo de nosotros?
(marque toda opcion que aplica)
*
Website/ Pagina web
My Kid's School/ Escuela de mis hijos
A flier/ un boletin
BSYC Easter Egg Hunt Event/ El evento de Pascua en BSYC
Dia del niño Event at BSYC/ Evento Dia del Niño en BSYC
Chuy DeLeon
Liz Tapetillo
Antisha Brown
Referred by Family member/ Referencia de un familiar
Referred by a BSYC volunteer/ Referencia de un voluntario de BSYC
Referred by a BSYC member/ Referencia de un miembro de BSYC
Other:
Required
What attracted you to BSYC?
Que le atrajo de nuestra organizacion?
*
Your answer
Do you have any further questions or comments?
Tiene algun otro comentario adicional?
*
Your answer
Thank you for your interest in BSYC. We will be contacting you soon . Many blessings.
Gracias por su interes en BSYC. Le contactaremos lo mas pronto posible. Muchas bendiciones
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