Interest Survey - We Want to Hear from You!!

1. Default Section

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* 1. Name:

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* 2. Phone Number:

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* 3. E-mail:

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* 4. My current address:

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* 5. Are you a:

Youth/Alumni

Adult Supporter/Community Partner

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* 6. 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.

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* 7. 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.

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* 8. 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).

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* 9. 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.

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* 1. Name:

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* 2. Phone Number:

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* 3. E-mail:

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* 4. My current address:

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* 5. Are you a:

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

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

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

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

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* 10. Others not mentioned above:

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

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

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

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