Thank you for your interest in the GYO program!

Please complete the information below and then schedule a brief introduction call with the GYO Program Coordinator (link to schedule at end of form).

If you are unsure on the response to a question, that is more than okay, just answer based on what you do know. The GYO Program Coordinator can coach you through the application- just send an email, call or text.

If you would prefer to complete these questions via phone with the GYO Program Coordinator, please email mschorr@cgesd.k12.or.us to set-up a brief phone/zoom call.

All information shared will be viewed by the GYO review committee only and not shared elsewhere without your written consent.

Please reach out with any questions!
mschorr@cgesd.k12.or.us OR 541.993.7935
Background Info & Demographics

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* 1. First name

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* 2. Last name

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* 3. Pronouns

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* 4. Email address

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* 5. Confirm email address

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* 6. Phone number

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* 7. Address

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* 8. What is your age?

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* 9. Select one or more boxes that reflect how you racially and/or ethnically self-identify.

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* 10. If applicable, what is your Tribal affiliation?

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* 11. What is your language of origin

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* 12. What languages do you speak and what is your fluency?

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* 13. What language do you prefer to communicate in?

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* 14. How do you describe your sexual orientation (i.e. gay, lesbian, bisexual, heterosexual, etc.)

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* 15. How do you describe your gender identity (i.e. woman, man, non-binary, etc.)?

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* 16. Do you have any dependents?

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* 17. What county do you live in?

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* 18. How long have you been an Oregon resident?

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* 19. What is your zipcode?

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* 20. What is the highest level of education you have completed?

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* 21. Please list degree(s), licensure(s), and/or endorsement(s) you have completed below

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* 22. Are you and/or would you be a first generation college student (A first-generation college student is a student whose parents did not complete a four-year degree)?

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* 23. Please mark which option below best describes where you are currently:

 
10% of survey complete.

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