Youth Leadership Forum for Community Transformation OKC Registration

YLFCT OKC Registration Form

Please note that you can save this form and complete at your own pace. To do this, please scroll to the very bottom of this form, click "SAVE" and follow the pop-up instructions.
About You!
Name*

First Name Last Name
Birth Date*

Month Day Year
Pronouns*

he/himshe/herthey/them
Race/Ethnicity 1*

AfricanAfrican American/ BlackAsian/ Asian AmericanBiracialHispanic/ LatinxNative/ IndigenousWhite/ European descent
Race/Ethnicity 2
ex. Nigerian, Hmong, Irish, Vietnamese, African American & Puerto Rican, etc.
Student Gender*

GenderfluidFemaleMaleNon-binaryTransgender
High School*
Expected Graduation Year*
Student Email*
example@example.com
Student Phone Number*
Mailing Address*

Street Address

Street Address Line 2 (ex. Apartment number, suite number, PO box, etc.)

City State

Zip Code
Various snacks and meals will be provided during the program. Please note if you have any allergies.*
Parent/Guardian Information
Parent/Guardian Name*

First Name Last Name
Parent/Guardian Phone Number
Parent/Guardian E-mail*
Long Answer Questions

Please respond to the following promots in 3-5 sentences.
Please list leadership activities you are involved in.*
Why you are interested in participating in the Youth Leadership Forum for Community Transformation?*
If you were to rate race relations in the Unites States from 1-10 (with 10 being "excellent" and 1 being "awful"), how would you rate it and why?*
If you were to rate race relations in your school or community from 1-10 (with 10 being "excellent" and 1 being "awful"), how would you rate it and why?*
Please upload your recommendation letter here. This can be completed by anyone who has seen you in a leadership role (ex. sports, club, youth group, etc.)*

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Cancelof
Please indicate your agreement to the following: "I commit to attending all three sessions on April 14, 15 and 22."

YesNo
If you answered "no" to the previous question, please briefly explain any special circumstances we should consider.
Informed Consent and Acknowledgement By submitting this form, you acknowledge that a parent/guardian has given their permission for your participation in all activities prepared by OCCJ during this program (if participant is under 18).

Details and Information Expect to hear from us on March 24th by email with more information and program logistics. If you have any questions about the Youth Leadership Forum before then, please contact OCCJ Programs Director, Cara Golden at cgolden@occjok.org.

Thank you for registering!
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YLFCT OKC Registration Form

About You!

Parent/Guardian Information

Long Answer Questions