Reality Check Member Interest Form

Reality Check Member Interest Form

Must be a 13-18 year old in middle or high school in order to join.
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Are you a parent, guardian or student?
What county does the student live in?
What grade is student currently enrolled in?
Student's Name

First NameLast Name
Student's Email Address
Parent or Guardian's Name

First NameLast Name
Parent or Guardian's Email Address
Thanks for your interest in the Delaware, Otsego, Schoharie Reality Check teen leadership program. After you hit the submit button our program staff will be notified. Within a day or two you should receive an email from Jordon.Fernandez@sjhsyr.org with instructions on how to fill out paperwork in order to enroll in the program.
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