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?*

Check All That Apply*

I am or will be a first generation college studentI am or was previously in the foster systemI am or was a juvenile offenderI have been convicted of a felonyI have been convicted of a misdemeanor
Are you currently working?*
If yes, please provide details below*
What is your ideal career?*
Where do you see yourself in the next 3 years?*
What do you expect to gain from this program?*
Please upload a clear headshot or selfie.*

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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

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Name of Applicant

First NameLast Name
Date Signed by Applicant

MonthDayYear
Date
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