One moment please...
Winter 2024 Y-WE Alum Cohort
Six-week online series
February 20-March 26, 2024
Every Tuesday, 5-7:15 PM PST
On Zoom
If you have any needs or questions, contact
aya@y-we.org
Please plan to complete this form in one sitting, you will not be able to save it mid-way through!
Y-WE Inclusion Policy
*Y-WE welcomes those who identify as a girl/woman, nonbinary, trans, and gender expansive. Most programs are open to youth ages 13-19.
Basic Information
Preferred First Name
*
Last Name
*
Pronouns
she/her, they/them, he/him, etc
Legal first name (if different)
Birthdate
*
(mm/dd/yyyy)
Age
*
Email
*
Verify Email
*
Phone Number
*
May we text you at this number?
*
Yes
No
Home Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Do you need any technology support to make the virtual elements of this program accessible to you? If yes, please describe:
Do you have any accommodation needs to make programs accessible and comfortable?
*
Disability accommodations, environmental sensitivities, neurodivergence accommodations, etc
select one
Yes
No
How can we best support you in this area?
Interests
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!
What made you interested in this program, and what are you hoping to gain from participating?
*
Is there anything else you would like us to know about your family, your schedule, or your commitment to this program?
*
Demographic Information
YY-WE collects this data to better understand who we serve, and to improve and obtain support for our programs. Your answers are confidential and we never shares personal or identifying information outside of Y-WE!
Do you identify as Black, Indigenous, or a Person of Color?
*
select one
Yes
No
Prefer not to answer
Other
OPTIONAL: If you selected 'Other' please describe:
Race/Ethnicity (check any/all that apply, or select 'prefer not to answer')
*
American Indian or Alaska Native
Indigenous
Asian
Black
African American
African
North African
Hispanic or Latino/Latinx
Middle Eastern
Mixed Race
Native Hawaiian or Pacific Islander
White
Prefer not to answer
Other
OPTIONAL: Tribal Affiliation
OPTIONAL: If you selected 'Other' please describe:
Gender Identity (select any/all that apply, or select 'prefer not to answer')
*
Agender
Girl or woman
Boy or man
Trans
Non-binary
Genderqueer
Gender neutral
Two spirit
Cisgender
Genderfluid
Prefer not to answer
Other
OPTIONAL: If you selected 'Other' please describe:
Do you identify as LGBTQIA+?
*
select one
Yes
No
Other
Prefer not to answer
OPTIONAL: If you selected 'Other' please describe:
Primary languages(s) spoken at home (select all that apply)
*
English
Amharic
Arabic
Chinese
Khmer
Korean
Punjabi
Russian
Somali
Spanish
Tagalog
Tigrinya
Ukrainian
Vietnamese
Other
Prefer not to answer
OPTIONAL: If you selected 'Other' please describe:
Place of Origin
*
Your answers are confidential! We do not ask for or keep any record of immigration status.
select one
I was born in another country and moved to the U.S.
I was born in the U.S. and one or more of my parent(s)/caregiver(s) were born in another country
I was born in the U.S. and my parent(s)/caregiver(s) were born in the U.S.
Prefer not to answer
Primary Household Type (where you live all or most of the time)
*
select one
One parent/caregiver family
Two parent/caregiver family
Foster care/foster family
Extended family (grandparents, aunt or uncle, etc)
Experiencing homelessness
Live independently (alone or with roommates)
Prefer not to answer
Other
OPTIONAL: If you selected 'Other' please describe:
Emergency Contact
Please provide information for someone we could contact on your behalf in an emergency.
Name
*
First Name
Last Name
Relationship to You
*
Phone Number
*
Email Address
*
Verify Email
*
Needs Support Check-In
Y-WE's Community Wellness and Mental Health team help connect Y-WE individuals and families with mental health and wellness support (and physical/financial resources when possible). These services are confidential. If you or your family is in need of immediate support, please email wellness@y-we.org.
Wellness and Mental Health Support
*
Is there anything you would like us to know about you or your family's wellness and mental health needs?
select one
Yes (describe below)
Not at this time
If yes, please describe:
Click 'submit' to complete your application. Please note that the form can take several minutes to process- DO NOT CLOSE THE WINDOW UNTIL YOU SEE THE CONFIRMATION MESSAGE!
.png-Horizontal+Logo+(transparent).png){kind=logo}