Section 1: Applicant Contact Information

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* First Name

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* Last Name

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* Pronouns (optional)

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* Date of Birth*

Date

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* Email

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* Phone

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* Zip Code

Section 2: Background Information

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* Ethnicity/Race
(Please check all that apply):

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* Sociodemographic Representation
(Please check all that apply):

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* Areas of Expertise
Please check all fields in which you have experience (professional, volunteer, personal or other):

Section 3: Your Interest

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* Tell us about your interest in the Transportation Industry. (300-word limit)

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* Tell us about your interest in joining the Youth Innovation Challenge. (300-word limit)

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* Are there any transit-related topics you are interested in? (300-word limit)

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* Tell us about your life and/or professional experience in reference to transportation, housing, planning, environmental justice, economies, advocacy, social justice, equity, and anything else you find may be related to your participation in the Youth Innovation Challenge. (300-word limit)

Section 4: Availability

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* Do you work?

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* Are you enrolled in school?

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* Hours available
This mentorship program starts on April 1 and ends in July 2024. Are you available to participate an approximate of 40–60 hours?*


*Additional time if advancing to the National Challenge

What days and times are you available?
This information will be used to plan in-person workshops, collaboration meetings, etc.
(Check all that apply)

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* Monday:

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* Tuesday:

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* Wednesday:

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* Thursday:

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* Friday:

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* Saturday:

For additional information about the AC Transit Local Youth Innovation Program,
contact Justin Augustine jaugustine@actransit.org / 510-332-1452
In conjunction with Metropolitan Transportation Commission and Iyai+

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