Teen Queens Rise Application

Teen Queens Rise Application

Teen Queens Rise is an 10-week sisterhood learning series for Black teen girls ages 13–19, including those who are pregnant or parenting. The program builds confidence, supports mental wellness, and strengthens healthy decision-making, communication, and relationships through culturally affirming conversations and activities. Sessions are co-facilitated using the Making Proud Choices curriculum, which focuses on informed choices, consent, healthy relationships, and pregnancy and STI prevention.
Name*

First NameLast Name
Email*
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Age (13-19)*
Zip Code*
YesNoUnsure
YesNoMaybe
T-shirt size?*
Parent/Guardian Information

Parental/guardian consent is required for participants under 18 and will be sent separately after this form is submitted.
Parent/Guardian Name

First NameLast Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Pre-Survey

Tell Us About You
I know where to find community resources that support me as a teen and/or young mom.*

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1 is Strongly Disagree, 5 is Strongly Agree
I know how to take care of my mental health and practice self-care.*

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1 is Strongly Disagree, 5 is Strongly Agree
I feel confident speaking up for myself and making choices that are best for me.*

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1 is Strongly Disagree, 5 is Strongly Agree
I have at least one adult and/or mentor I trust and can go to for support.*

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1 is Strongly Disagree, 5 is Strongly Agree
I feel connected to other young women who share similar experiences.*

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1 is Strongly Disagree, 5 is Strongly Agree
I feel proud of who I am and the journey I’m on.*

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1 is Strongly Disagree, 5 is Strongly Agree
I feel confident planning for my future (goal setting and staying organized).*

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1 is Strongly Disagree, 5 is Strongly Agree
I feel confident avoiding risky situations and/or behaviors (such as unsafe relationships, risky internet use, or substance use).*

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1 is Strongly Disagree, 5 is Strongly Agree
FriendsFamilyChurchTeachers/schoolSocial media (IG, FB, TikTok, Youtube, etc)News websites/appsOther
If you said "other" list here
Confidence & self-esteemHealthy relationships & communicationMental health & self-careDecision-making & goal settingLeadership & finding my voicePregnancy or parenting supportFinding community resourcesOther
If you said "other" support list here
I understand that Teen Queens Rise is an 10-week series held on Saturdays from 10:00 AM–1:00 PM. I understand that to receive the completion stipend of $300, I must attend at least 8 out of the 10 sessions + Annual Empowerment Summit.
I understand that the majority of Teen Queens Rise sessions will be hosted at Barnett Library but other library locations may be used, based on room availability. All alternative locations will be communicated to youth and guardians ahead of time.
I understand that parental/guardian consent is required for participants under the age of 18. A consent form will be sent separately and must be completed before participation is confirmed.
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Teen Queens Rise Application

Parent/Guardian Information

Pre-Survey