Spring 2015 Youth Advisory Board Application

Please note, you cannot save this form. It must be completed and submitted in one session. We recommend working on your answers in a separate application and inputting them all at once. Questions or technological issues? Contact Dave Sandoval at [email protected].

Basic Information

Full Name: *

Birth Date: *

(MM/DD/YYYY)

Address: *

Gender:

Female

Male

Unspecified

City: *

Home Phone: *

(XXX)-XXX-XXXX

Cell Phone: *

(XXX)-XXX-XXXX

Email Address:

School: *

What is the best way to contact you? *

(e.g. text message, email, etc.)

Youth Advisory Board Application

How did you hear about SoEx’s Community Arts Internship Program (CAIP)? *

Why do you want to join CAIP and what do you hope to learn? *

Are you an artist (you don't have to be to join!)? What do you like to make? *

Do you participate in any other activities outside of school? *

If yes, please specify.

Who are your favorite artists, leaders, speakers, musicians and writers? *

What language(s) do you speak? *

Do you have any special needs (i.e. 1:1, IEP, etc.)? *

If so, please specify.

Parent/Guardian Information (if under 18)

Full Name: *

Address: *

City: *

Phone Number: *

(XXX)-XXX-XXXX

Email Address:

Emergency Contact Information

Full Name: *

Address: *

City: *

Phone Number: *

(XXX)-XXX-XXXX

Relationship: *

Hit "Submit" only once! Please give the system time to process your application. Do not navigate away from this page until you get a confirmation message.

Leave this field blank

Southern Exposure

☰

Spring 2015 Youth Advisory Board Application