BYEP Youth Application
Remember to hit submit at the bottom when you're all done!
Name
*
What grade are you currently in?
*
Please Select
6
(Summer Before) 7th Grade
7
(Summer Before) 8th Grade
8
(Summer Before) 9th Grade
9
(Summer Before) 10th Grade
10
(Summer Before) 11th Grade
11
(Summer Before) 12th Grade
12
If it's summer, tell us what grade you're going into.
What school do you go to?
*
What's your email?
No worries if you don't have one! Just leave this blank if you don't.
What's your birthday?
*
-
Month
-
Day
Year
What's your gender?
male
female
non-binary
prefer not to answer
Let us know your digits.
If you don't have a phone, leave this blank.
Format: (000) 000-0000.
Primary language:
English
Spanish
Other
What's your address?
City
State
Zip
What's your parent or guardian's name?
*
Can you let us know your parent or guardian's phone number?
Format: (000) 000-0000.
What's your parent or guardian's email?
If you don't know, leave this blank.
What is your parent or guardian's birthday?
-
Month
-
Day
Year
If you don't know, leave this blank.
What is their relationship to you?
*
How'd you hear about BYEP?
*
Please Select
A friend told me about it.
I found it on the internet through search or social media.
My parent/guardian told me about it.
A probation officer told me about BYEP.
My teacher, school counselor, or someone else at school.
A mental health counselor, not from my school, let me know about BYEP.
Other
If other, how'd you find out about BYEP?
How many times have you moved in your life?
*
I feel safe and secure at home.
*
Yes
Sometimes
No
I care about school.
*
Yes
Sometimes
No
I stay away from tobacco, alcohol, and other drugs.
*
Yes
Sometimes
No
Money is not a stressor in my family.
*
Yes
Sometimes
No
I overcome challenges in positive ways.
*
Yes
Sometimes
No
I feel good about myself.
*
Yes
Sometimes
No
I have friends who set good examples for me.
*
Yes
Sometimes
No
I have adults who are good role models for me.
*
Yes
Sometimes
No
I feel in control of my life and future.
*
Yes
Sometimes
No
I have a family that gives me love and support.
*
Yes
Sometimes
No
I feel valued and appreciated by others.
*
Yes
Sometimes
No
Have you ever been in trouble with the law?
*
Yes
No
Have you ever been in residential treatment?
*
Yes
No
Do you or your family participate in programs like free or reduced-price lunch at school? If you're not in school, do you feel like your family struggles financially to make ends meet?
*
Yes
No
What do you enjoy doing?
*
Why do you want to join BYEP?
*
What is the biggest challenge in your life right now?
*
What strengths will you bring to BYEP? What makes you rock?
*
In your own words, what is BYEP?
*
Please verify that you are human
*
Submit
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