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Reality Check Member Interest Form
Eligibility: Reality Check members must be 13-18 years old (middle and high school level) and live in Albany, Rensselaer or Schenectady County.
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* Indicates required question
RC applicant name (First and last)
*
Your answer
Parent or Guardian Name
Your answer
Who is completing this form?
*
Reality Check applicant
Parent or Guardian
Other:
County of residence
*
Albany County
Rensselaer County
Schenectady County
Please indicate school applicant attends
Your answer
Grade level
*
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Other:
How can we contact you? Check as many as appropriate.
*
Email
Cell phone
Home phone
Other:
Required
Email
Your answer
Phone - Please provide cell and/or home number including area code.
Your answer
Thanks for your interest in the Capital District Reality Check teen leadership program. After you submit this form, one of our team members will contact you.
Your answer
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