Reality Check Member Interest Form

Reality Check Member Interest Form

Must be a 13-18 year old in middle or high school in order to join.
Today's Date

Month Day Year
Are you a parent, guardian or student?

Parent Guardian Middle School Student High School Student
What county does the student live in?

Albany County Schenectady County Rensselaer County
What grade is student currently enrolled in?

7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade
Student's Name

First Name Last Name
Student's E-mail Address
Parent or Guardian's Name

First Name Last Name
Student's Cell Phone Number
Before you hit submit, don't forget to follow us on our social media platforms!
Thanks for your interest in the Capital District Reality Check teen leadership program. After you hit the submit button our Youth Engagement Coordinator will be notified. Within a day or two you should receive an email from Cara.Zampi@sphp.com with instructions on how to fill out paperwork in order to enroll in the program.
Should be Empty:

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