The Safe PlaceMN Youth Development Pathways Registration

The Safe PlaceMN Youth Development Pathways Registration
Youth Information
First Name
Last Name
Preferred Name / Nickname
Age
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
ZIP Code
City
School or Current Education/Training Program
Grade Level or Status
Interests and Support Needs
What are you interested in?

Other
List 3 things you hope to gain by joining the Youth Development Pathways Entrepreneurship cohort?
What do you already know about entrepreneurship?
What barriers are you currently facing that may be stopping you from reaching your goals and aspirations? Feel free to be vulnerable. You're in a safe place.
Will you be able to commit to all 6 weeks of the YDP cohort?
Upon graduation, would you be interested in becoming a peer mentor for new participants?
Would transportation make it difficult for you to attend?
What transportation support would help?

Other
Do you need any other support to participate?

Other
How did you hear about The Safe PlaceMN?
Contact Permission and Guardian Details
May The Safe PlaceMN contact you about future programs, events, resources, and opportunities?
Parent/Guardian First Name

First NameLast Name
Parent/Guardian Last Name

First NameLast Name
Relationship to youth
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Should be Empty: