SEPA Mujer Girls A.C.T. Youth Program
General Application / Aplicación General

GIRLS ACT is an ongoing program that engages the youth in civic engagement and leadership. We accept applications year-round. The Girls A.C.T program has 3 different parts:

Girls A.C.T Chapter meetings in our Patchogue office (2x monthly meetings September-May)

Summer Leadership Academy (5 days a week paid program July-August) 

Latina Leadership Council (In High School Program) (October-May)



Thank you for your interest in joining Girls A.C.T. Please fill out to the best of your ability / Gracias por su interés de unirse al Girls A.C.T. Por Favor llene este formulario lo mejor posible.

(631) 980-2555 | www.sepamujer.org 
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First Name / Primer Nombre: *
Last Name / Apellido *
D.O.B. / Fecha de Nacimiento *
Address (number, street, town, & zip code) / Dirección (numero, calle, pueblo y codigo postal): *
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What high school do you attend? / A qué escuela secundaria asistes?
What grade are you in? / En que grado estás?
What university do you attend? / A qué universidad asistes?
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