Quality Youth Development (QYD) Application
QYD does not discriminate based on race, ethnicity, sex, creed, national origin or disability. This information need not be provided. It is requested to facilitate the QYD goal of establishing a diverse group.  Omitting this information will not affect your application.


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Name *
Preferred Name (if different)
Preferred pronoun
Gender Identity
Age *
Race(s) or ethnic group(s) that you identify yourself as (check all that apply)
School that you attend
Grade you are in
Who recommended QYD to you?
Home Address
Phone number (if you have one)
Email address *
 Best way to communicate with you:  
Parent/Guardian Name *
Parent/Guardian phone number
Parent/Guardian email
Why do you want to join our QYD Steering Committee?   *
What skills, perspectives, knowledge, etc. do you think you would bring to the group? *
What are the three most important issues to you, your friends and your familyconcerning your community? *
Are you willing to attend the QYD meetings, events and activities and commit to making a difference in Brattleboro? *
Required
I have read and understand the commitment required for the QYD Steering Committee. I also realize the importance of teamwork and cooperation and I am willing to make this commitment *
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