GENERAL INTEREST & COMMUNITY INTAKE
Programs, suggestions, mentors, volunteers, internships, and partnerships
Use this form to express interest in a YEP activity, suggest a new program, or offer your time, skills, placement opportunity, or partnership. YEP will follow up as opportunities become available.
CONTACT INFORMATION
Full Name *
*
First Name
Last Name
Organization / School (if applicable)
Age (if under 18)
Parent / Guardian Name (if under 18)
First Name
Last Name
Phone *
*
Format: (000) 000-0000.
Email *
*
example@example.com
Address / Neighborhood / ZIP
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I am completing this form as a:
Youth / Participant
Parent / Guardian
Mentor
Volunteer
Intern / Student
Instructor / Facilitator
Community Partner
Sponsor / Business
PROGRAM INTERESTS
Activities of interest (check all that apply):
Media & Storytelling
Photography
Video Production
Podcasting / Audio
Creative Arts
STEAM / Technology
Entrepreneurship
Career Readiness
CDL / Transportation
Mentoring / Leadership
Other
Which specific activity or program interests you most, and why?
Suggest a new activity, class, workshop, or training program for YEP:
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MENTOR, VOLUNTEER, INTERNSHIP, OR PARTNERSHIP INTEREST
I would like to be considered for:
Mentor
Volunteer
Internship
Student Placement / Practicum
Guest Speaker
Workshop Leader
Instructor / Facilitator
Program Partner
Sponsor / Donor
Employment / Career Partner
Relevant skills, experience, certifications, or resources you can offer:
What population, subject, or activity would you prefer to support?
General Availability
Preferred Start Timeframe
Best Days / Times
Preferred Contact Method
Links, portfolio, resume, social media, or professional profile (optional):
ACKNOWLEDGMENTS
Please check each applicable statement:
I understand this is an interest form and does not guarantee placement.
I agree to be contacted about YEP programs and opportunities.
If working with minors, I am willing to complete required screening and clearances.
I confirm that the information provided is accurate to the best of my knowledge.
Applicant Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
YEP Staff Use: Referred To / Follow-Up Date / Notes
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