Registration for YPA Level Two In-Person Training (LONG ISLAND)

Dates: April 21-22, 2020 9AM-5PM
Location TBA

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* 1. Contact information

Full Name *

Address

Address 2

City / Town

State / Province

ZIP / Postal Code

Email *

Phone *

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* 2. Please list the following information relating to your position as a Youth Peer Advocate

Organization Name:

Your Title:

Organization Location:

Full time, part time or per diem:

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* 3. In order to participate in the Level Two in-person training, you must meet the following qualifications. Please check off the qualifications that you meet.

I hold a valid YPA Provisional Credential

I have completed Level Two of the YPA online training

I am providing services that fall within the role of a YPA

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* 4. I will be able to fully participate in both days of the training.

Yes

If you are unable to participate in the full training, explain why. This may affect your ability to complete the training and move onto the next step in the credentialing process.

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* 5. List allergies and disability accommodations that the trainers should know about:

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* 6. I agree to appear in audio, video or print media for public relations, advertising, web development, commercial productions, documentaries, educational broadcast presentations, as well as any other forum to the benefit of YOUTH POWER! and Families Together in NYS.

I understand that YOUTH POWER! and Families Together in NYS will have ownership of all recorded materials and I agree that YOUTH POWER! and Families Together in NYS may use my image and voice in any manner. I understand and agree that YOUTH POWER! and Families Together in NYS has the right to reproduce and distribute these materials and that I will not receive any form of compensation.

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* 7. Code of Conduct:
I have chosen to attend this event and will participate in discussion and activities. I will help to create a youth peer community based on mutual respect and a sense of personal wellbeing. I agree to refrain from sexual behavior and public displays of affection while attending the YP! event. I will not bring or use any weapons, firearms, or anything that may be construed as a weapon. I will not possess, use, or distribute any illegal drug or drug paraphernalia. I will not commit any illegal act. I will treat others with honor and respect because that is how I wish to be treated.
Signed (type your name),

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* 1. Contact information

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* 2. Please list the following information relating to your position as a Youth Peer Advocate

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* 3. In order to participate in the Level Two in-person training, you must meet the following qualifications. Please check off the qualifications that you meet.

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* 4. I will be able to fully participate in both days of the training.

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* 5. List allergies and disability accommodations that the trainers should know about:

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* 8. If you have any questions or comments please list them here or contact Joanna Ahlatis at joanna@ftnys.org