Youth Engagement Application

You can write your answers to these question through this page, or on zoom with the Youth Engagement and Empowerment Coordinator.  If you have any questions, or you need help with this application please contact:
Rachel Shandler,  Youth Engagement and Empowerment Coordinator
Email: rshandler@spanadvocacy.org
Phone: 215-550-1340

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* 1. Name:

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* 2. Age:

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* 3. Email:

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* 4. Phone number

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* 5. What state do you live in?

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* 6. What is your race/ethnicity?

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* 7. Are you Latinx or Hispanic?

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* 8. What is your Preferred Language

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* 9. Are you a member of the LGBTQIA community?

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* 10. Do you have an intellectual and/or developmental disability?

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* 11. If you have a disability, please describe it?

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* 12. What disability accommodations do you need to participate in an online meeting? 

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* 13. What opportunities are you interested in? Check all that apply

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* 14. If you are a youth, or a parent/guardian of a youth who is under 18, (minor) we must have a parent or guardians signature. Please type the the name and email of the parent or guardian below

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