Interest Survey - We Want to Hear from You!!

1. Name:

Name:

2. Phone Number:

Phone Number:

3. E-mail:

E-mail:

4. My current address:

My current address:

5. Are you a:

Are you a: Youth/Alumni

Adult Supporter/Community Partner

6. Areas of Interest (Please check what you are interested in.):
Action Areas for GA EmpowerMEnt

Areas of Interest (Please check what you are interested in.): Action Areas for GA EmpowerMEnt Designing/Developing information materials on GA EmpowerMEnt (brochures, posters for schools and DFCS offices, etc.)

Designing/Developing and managing a GA EmpowerMEnt Website, social networking sites, and use of cutting-edge technology.

Designing/Developing and managing a GA EmpowerMEnt newsletter to keep people in the loop.

Contribute your talents as an artist or musician to GA EmpowerMEnt's efforts.

7. Areas of Interest (Please check what you are interested in.):
Action Areas for GA EmpowerMEnt

Areas of Interest (Please check what you are interested in.): Action Areas for GA EmpowerMEnt Public Speaking/Presentations/Media opportunities - speak on important issues - Atlanta AND local to your community.

Training - identify the training needs for GA EmpowerMEnt and help locate and coordinate trainings.

8. Areas of Interest (Please check what you are interested in.):
Action Areas for GA EmpowerMEnt

Areas of Interest (Please check what you are interested in.): Action Areas for GA EmpowerMEnt Finding resources, "door openers," and partners in your community to support GA EmpoweMEnt/Resource Development and Community Partnerships.

Helping GA EmpoweMEnt together with designing a structure and plan.

Helping GA EmpowerMEnt with collecting and analyzing information that will measure our progress (Self-Evaluation).

9. Areas of Interest (Please check what you are interested in.):
Issues of Focus

Areas of Interest (Please check what you are interested in.): Issues of Focus Extending Medicaid/health insurance for youth until 21.

Teen moms and fathers remaining with their children while in care.

More stable school/educational experiences.

Networks of caring, consistent, permanent relationships for foster youth.

Driver's license needs.

Better relationships with caseworkers.

Sibling/family visitation.

Homelessness

Youth involved with DJJ and DFCS.

Youth who have disabilities.

Youth for whom English is a second language.

Youth who identify as LGBTQ.

Making laws/court processes better for kids and families.

Youth with mental health/behavior needs.

10. Others not mentioned above:

Others not mentioned above:

Interest Survey - We Want to Hear from You!!

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