Sentinels - Formstack

"Sentinels" Application Form

Thank you for your interest in the "Sentinels" program! Please fill out the following information and complete the Teacher Agreement at the end of this survey. Once you have submitted this form, we will email you with the next steps.
Name

First NameLast Name
Email*
Where did you hear about "Sentinels"?

An Unbound Now OfficeAnother EducatorSocial Media/OnlineOther
Please select the title/role that best describes you:*
In which Texas county are you located?*
I want to preview the program

I want to preview the programI am ready to implement the program
Will you be facilitating Sentinels with a group or in a one-on-one setting?

Group (ie. school, class, group program, etc.)One-on-One (just you and one youth, ie. parent, CASA, advocate)
Sentinels 1:1
Please select the context in which you are facilitating Sentinels one-on-one?

Parent with my childCASA with youthAdvocate with clientCourt Program with juvenile
What grade is your youth currently in?
Which best describes the community in which the youth resides?

RuralUrbanSuburban
When do you plan on implementing Sentinels?

Fall 2023Spring 2024Summer 2024Fall 2024
Why are you planning to implement Sentinels with this youth?
How do you plan on implementing Sentinels? (ex. once a day for a week, once a week for 5 weeks, etc.)
Check all the vulnerabilities you identify in your students:

Poverty/Low socioeconomic statusA lot of unsupervised timeLack of connection to one or both parentsHistory of abuseHistory of substance useInvolvement with Child Welfare/CPSRisky online behaviorsHyper-sexualized language or behaviorGang involvementA party cultureMental health concernsEngaging in sexual acts in exchange for anything of value
What is the most significant need of this youth that you hope "Sentinels" will address?*
What is your action plan should this student disclose an instance of abuse or trafficking?
Sentinels for Groups
Please select the context in which you are facilitating Sentinels?

Public/Private School ClassroomHomeschool GroupOther Youth Program
Which grade(s) is/are the youth currently in? If they are between grades, please select the grade they are about to enter.

5th6th7th8th9th10th11th12th
Role/Title*
School District/Organization
I am a decision maker for my community requesting to preview “Sentinels” before it is implemented with our students.

YesNo
Which best describes the community in which the youth resides?

RuralUrbanSuburban
Check all the vulnerabilities you identify in your students:

Poverty/Low socioeconomic statusA lot of unsupervised timeLack of connection to one or both parentsHistory of abuseHistory of substance useInvolvement with Child Welfare/CPSRisky online behaviorsHyper-sexualized language or behaviorGang involvementA party cultureMental health concernsEngaging in sexual acts in exchange for anything of value
When do you plan on implementing Sentinels?

Fall 2023Spring 2024Summer 2024Fall 2024
How do you plan on implementing Sentinels? (ex. once a day for a week, once a week for 5 weeks, etc.)
Have there been reports of sex trafficking in your district?

YesNoUnsure
Is your district actively discussing sex trafficking with students, staff and parents/guardians?

YesNoUnsure
Does your district have an established, well-communicated protocol for responding to cases of suspected or identified sex trafficking?

YesNoUnsure
What is the most significant need of your students that you hope "Sentinels" will address?*
Should be Empty:

"Sentinels" Application Form

Sentinels 1:1

Sentinels for Groups