Youth Promoting Peace Program 1. Application Page1 / 1 100% of survey complete. Question Title * 1. Please tell us about yourself (youth) Name Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Email Address Phone Number Question Title * 2. I am interested in: The session beginning March 3, 2023 (14-17 year old males only) - APPLICATIONS DUE BY FRIDAY, FEBRUARY 17TH! Future sessions (April - December 2023) Question Title * 3. Parent/Guardian/Caregiver #1 Information Name Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Email Address Phone Number Question Title * 4. Parent/Guardian/Caregiver #2 Information Name Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Email Address Phone Number Question Title * 5. Race Black or African American Hispanic or Latino Asian or Asian American American Indian or Alaska Native Native Hawaiian or other Pacific Islander White or European American Biracial Multiracial Prefer not to say Other (please specify) Question Title * 6. What is your gender identity? Male Female Non-binary Transgender Prefer not to say Other (please specify) Question Title * 7. What are your preferred pronouns? She/her/hers He/him/his They/them/theirs Prefer not to say Other (please specify) Question Title * 8. What is the name of your school? Question Title * 9. What grade are you in? 5th grade 6th grade 7th grade 8th grade 9th grade 10th grade 11th grade 12th grade College I am not in school Question Title * 10. Please rate how safe you feel at school. Very unsafe Somewhat unsafe Very safe Somewhat safe Neither safe nor unsafe I don't know I prefer not to say Question Title * 11. Please rate how safe you feel in your neighborhood. Very unsafe Somewhat unsafe Very safe Somewhat safe Neither safe nor unsafe I don't know I prefer not to say Question Title * 12. Please rate how safe you feel in the home you live in. Very unsafe Somewhat unsafe Very safe Somewhat safe Neither unsafe or safe I don't know I prefer not to say Question Title * 13. How often have/do you witness violence? Never 1-2 times per year 3 or more times per year 1-2 times per month 3 or more times per month 1-2 times per week 3 or more times per week 1-2 times per day 3 or more times per day Question Title * 14. What activities do you participate in after school and/or on the weekends? Sports league Boy Scouts Girl Scouts Music Dance Writing Homework help/tutoring Other I'd prefer not to say I don't participate in any activities Other (please specify) Question Title * 15. I will need transportation to the program Yes - one way to Northern Yes - one way from Northern to my home Yes - both to Northern and from Northern to my home I will not need transportation Question Title * 16. Do you have any dietary allergies or restrictions? If yes, please list. Done