Young Women Empowered · 2021 Spring - Theater of the Empowered

Youth Information

This form is for young women*, ages 13-18, who wish to enroll in Y-WE Programs. Some sections must be filled out by a parent/guardian. Please look over the application below and prepare to complete and submit it in one session. You WILL NOT be able to save the form mid-way through. Upon completion of this application, you will be contacted by a Y-WE staff member to set-up an interview.

Y-WE Inclusion Policy

*Y-WE welcomes people who identify as women or girls; were socialized as women or girls; or who were assigned female at birth.

Youth Information

Name

*

First Name

Last Name

Preferred first name (if different)

What are your gender pronouns? (optional)

she/her, they/them, he/him, etc.

Age

*

Birthdate

*

(mm/dd/yyyy)

Email

*

Phone Number

*

May we text you at this number?

*

Yes

No

Home Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

What grade are you in this year? (2021-2022 school year)

*

If you are in school, what school do you attend? (2021-2022 school year)

Do you have any dietary restrictions or food allergies? (for example: vegetarian, halal, allergic to peanuts, etc).

*

Are there any accommodations you need to make this program accessible and comfortable? (physical space needs, technology support, environmental sensitivities, etc). If none, please write 'none.'

*

Y-WE is dedicated to creating inclusive spaces and programs for all, including people with disabilities and specific accommodation needs.

Youth Interests Information

Your answers to these questions help us to get to know you better and understand what inspired you to apply to Y-WE. We shape our programs around the passions and goals of the youth who participate, so your answers to these questions really matter to us!

How did you learn about Y-WE?

*

What do you hope to gain from participating in this program? What are some of your personal goals?

*

Is there anything else you would like us to know about your family, your schedule, or your commitment to this program?

[Other things you want to ask???? If not delete this field]

I understand the commitment I am making to Y-WE

*

Since we have limited space in all our programs, and we want to make sure you get the most out of your Y-WE experience, we require a commitment from you to participate in all activities related to the program you are signing up for. If you miss our events regularly, without pre-approval from the program director, we may ask you to leave the program and offer your spot to someone else who can fully take advantage of the opportunity.

Yes, I understand the commitment I am making to Y-WE

Covid-19 Safety

*

The health and safety of the Y-WE community is always a priority! Program participants must wear a mask while at the program, maintain social distancing where possible, and agree to follow Covid Safety practices specific to this program.

I agree to follow Y-WE's Covid Safety guidelines

Please upload a picture of yourself that you like

*

Youth Demographic Information

Y-WE collects this data to better understand who we serve, and to improve and obtain support for our programs. Your answers are confidential and will not be shared outside of Y-WE except as part of anonymous percentages.

Do you identify as Black, Indigenous, or a Person of Color?

*

If you selected 'Other' please describe (optional):

Do you identify as LGBTQIA?

*

If you selected 'Other' please describe (optional):

Country of Origin (your answers are confidential and we do not ask about immigration status)

*

Primary Household Type (where you live all or most of the time)

*

If you selected 'Other' please describe (optional):

Are you eligible for free or reduced school lunch?

*

Parent/Guardian Info

Please fill this section out completely so that we can contact you about upcoming events and notify you if any emergency situation were to arise while this young person is at our program.

Parent/Guardian First Name

*

Parent/Guardian Last Name

*

Parent/Guardian(s) Phone:

*

Parent/Guardian(s) Alternate Phone:

Parent/Guardian(s) E-mail Address:

*

Parent/Guardian(s) Alternate E-mail Address:

Parent/Guardian(s) Mailing Address (if different from youth's home address)

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Please tell us a bit about why you are encouraging this young person to sign up for Y-WE, and if there's anything you'd like us to know about them.

I understand the commitment I am making to my young person and to Y-WE :

*

Yes

Y-WE must have Hold Harmless and Medical forms on file for each participant before the program begins, signed by a parent/guardian. These forms will be sent to you once enrollment is confirmed. Youth 18+ can fill out these forms on their own behalf.

*

I understand that my young person cannot participate in programs until I have completed these forms

Needs Support Check-In

Wellness and Mental Health Support

*

Y-WE's Community Wellness and Mental Health Specialist (Shaena, she/her) helps connect Y-WE individuals and families with mental health support and practical resources (such as rental assistance, grocery support, etc). Would you like Shaena to contact you about a need you or your family has? These calls are confidential. If you'd like to schedule an immediate appointment with Shaena, go to this link: https://calendly.com/shaenaywe/wellness

Is there anything else you'd like us to know about you or your family's wellness or support needs?

Theater of the Empowered!