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Youth Development Initiative Application Questions

You may provide your answers in writing. This application may also be completed via zoom with the Youth Engagement and Empowerment Coordinator. If you have any questions, or you need assistance completing the application please contact Rachel Shandler, the Youth Engagement and Empowerment Coordinator Email: rshandler@spanadvocacy.org
Phone: 215-550-1340

Applications are due November 15th 2022

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* 1. Name:

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* 2. Pronouns:

She/Her/Hers

He/Him/His

They/Them/Theirs

ze/hir

other

Other (please specify)

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* 3. Age:

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* 4. Email:

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* 5. Phone number

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* 6. Address:

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* 7. City:

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* 8. State:

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* 9. Zip Code:

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* 10. Preferred Way to be Contacted:

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* 11. Which race/ethnicity best describes you? (Please choose only one.)

Indigenous, Native American, American Indian, or Alaskan Native

Asian / Middle Eastern

Black or African American

White / Caucasian

Pacific Islander or Native Hawaiian

I don't want to answer

Multiple ethnicity / Other (please specify)

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* 12. What is your Preferred Language

English

Spanish

Vietnamese

Korean

Arabic

Guajarati

Hindi

Russian

French/French Creole

Chinese

Somali

American Sign Language (ASL)

Other (please specify)

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* 13. Sexual Orientation:

Lesbian

Gay

Bisexual

Queer

Asexual or ace romantic

Straight or heterosexual

Pansexual

Aromantic or aro spectrum

Indigenous or cultural identity (such as two-spirit)

Questioning: I am still trying to figure out my sexual orientation

I don't know what this question means

Prefer not to say

I want to describe in my own words

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* 14. Some people also identify as Latinx or Hispanic

Yes

I do not know what this question means.

Prefer not to say

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* 15. Gender: How do you identify?

Man or boy (including transgender man or boy)

Non-binary, genderfluid or genderqeer

Woman or girl (Including transgender girl or woman)

Indigenous or other cultural identity (two spirited)

I am questioning: I am still figuring out my gender identity

I don't know what this question means

Prefer not to say

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* 16. Do you have a disability?

Yes

I don't know

I prefer not to say

Youth Development Initiative Application Questions

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* 1. Name:

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* 2. Pronouns:

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* 3. Age:

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* 4. Email:

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* 5. Phone number

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* 6. Address:

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* 7. City:

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* 8. State:

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* 9. Zip Code:

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* 10. Preferred Way to be Contacted:

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* 11. Which race/ethnicity best describes you? (Please choose only one.)

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* 12. What is your Preferred Language

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* 13. Sexual Orientation:

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* 14. Some people also identify as Latinx or Hispanic

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* 15. Gender: How do you identify?

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* 16. Do you have a disability?

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* 17. If you answered yes to the previous question, please explain?

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* 18. Do you know what disability accommodations you need? If you do, please list them. (It is ok if you don't).

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* 19. Why do you want to be part of the Youth Development Initiative?

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* 20. How did you hear about this opportunity?

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* 21. Due to the youth being a minor, (under 18) we must have a parent or guardians signature. Please type the name of the parent or guardian below