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12
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1
Name
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First Name
Last Name
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2
E-mail
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3
Contact Information:
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Zip Code
Phone Number
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4
How old are you?
(example: 15 1/2 )
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5
What Youth Program are you interested in? (check all that apply)
Car and Driver 101
Swag & Grace
Public Relations: theYCA Club
OG Cares Labs #YouthAtWork
Entrepreneurship & Business Development
Pet Education Drive (PED): Pilot Program
Project: REGULATE ft. oGc
Impact Initiators
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6
Do you have a Driver's License
Please Select
Yes - I am licensed
No - Never Applied
No - Failed DMV Tests
Other
Please Select
Please Select
Yes - I am licensed
No - Never Applied
No - Failed DMV Tests
Other
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7
Would you be interested in volunteer opportunities within Our Generation Cares?
Yes
No
Maybe
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8
Do you have any specific life skills or talents that you would like to develop further?
Communication: Pubic Speaking
Critical-thinking: Problem Solving
Creativity: Creator or Maker
Collaboration: Relationship Management
Confidence & Courage: Presentation & Leadership
No skills yet - need help
Other
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9
How did you hear about Our Generation Cares programs?
Via Our Generation Cares
Via Social Media
City of Long Beach schools, government, and/or affiliates
A friend/family told me to apply
Attended a community event
Other
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10
What do you hope to gain from participating in our youth programs and initiatives?
Please share your thoughts
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11
Comments or questions?
Don't be shy and share your thoughts
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12
Image Field
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