We Express Us Podcasting Registration Form

We Express Us Podcasting Registration Form

Register for the year-round youth podcasting program, limited to 25 participants, running from April 1, 2026, to April 1, 2027. Please have your details ready.
Participant Information
First Name*
Last Name*
Date of Birth*

MonthDayYear
Date
Age*
Gender

FemaleMaleNon-binaryPrefer not to sayPrefer to self-describe
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
School or Current Educational Status
Grade Level
Employment Status
Preferred Method of Contact*

EmailPhoneText Message
How did you hear about the program?*
Program Eligibility and Acknowledgments
I confirm that I am between 14 and 24 years old.*

Yes
I understand that spaces are limited and that submission does not guarantee acceptance if the 25-participant limit has already been reached.*

I Understand
I confirm that I am available for the full program dates of April 1, 2026 to April 1, 2027.*

Yes
I agree to the participation expectations and acknowledge that I am responsible for following program guidelines and requirements.*

I Agree
Podcasting Interests and Experience
Communication Interests*

PodcastingPublic SpeakingInterviewingContent CreationStorytellingAudio ProductionOther
Prior Podcasting Experience*

1

2

3

4

5

6

7

8

9

10

1 is No experience, 10 is Extensive experience
Prior Public Speaking Experience*

1

2

3

4

5

6

7

8

9

10

1 is No experience, 10 is Extensive experience
Prior Interviewing Experience*

1

2

3

4

5

6

7

8

9

10

1 is No experience, 10 is Extensive experience
Prior Audio Recording Experience*

1

2

3

4

5

6

7

8

9

10

1 is No experience, 10 is Extensive experience
Prior Content Creation Experience*

1

2

3

4

5

6

7

8

9

10

1 is No experience, 10 is Extensive experience
Preferred Area of Focus*
Goals for Joining the Program*
Support or Accessibility Needs
Transportation Needs
Medical or Allergy Information Relevant to Participation
Additional Comments
Emergency Contact Information
Emergency contact name*

First NameMiddle NameLast Name
Relationship to participant*
Emergency contact phone*
Please enter a valid phone number.Format: (000) 000-0000.
Media and Medical Consent
Photo and Media Release Acknowledgment*

I agree to the use of my photo, video, and audio recordings for program-related purposesI do not agree
Emergency Medical Treatment Authorization*

I authorize emergency medical treatment if neededI do not authorize
Guardian Consent and Signature
Parent/Guardian Name*

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

MonthDayYear
Date
Should be Empty:

We Express Us Podcasting Registration Form

Participant Information

Program Eligibility and Acknowledgments

Podcasting Interests and Experience

Emergency Contact Information

Media and Medical Consent

Guardian Consent and Signature