Game Changing Youth Program

Game Changing Youth Program

The GCM Youth program is specifically focused on providing mentorship to transgender, gender non-conforming, and non-binary youth ages 18-25 in Atlanta Georgia.
Legal Name

First NameLast Name
Email
example@example.com
Chosen Name(NA if this is your legal name also)

First NameLast Name
Date of Birth

MonthDayYear
Date
Race
Gender
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Educational Information
Name of High School Attended
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Year Graduated(Type NA if you haven't graduated yet)
Did You Graduate?
Date Expected to Graduate

MonthDayYear
Date
Academic awards and/or honors you have received(NA if you have not received any yet)
Are you a member of any organizations, fraternities, or clubs? (NA if this doesn't apply)
Have you attended any college or university or are you currently attending?
If you answered yes, what is your major?(NA if this does not apply)
If yes please provide the month and year of your graduation or anticipated graduation.
Would you like to attend college or university?

By signing and submitting this completed form you are agreeing that if selected to participate in this program you will be present at each monthly session, 1-on-1's with your mentor, attend any in person convenings and graduation.
Applicant's Signature
Name of Applicant

First NameLast Name
Date Signed by Applicant

MonthDayYear
Date
Should be Empty: