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Welcome to the TRIGGER University's Protection Plan Interest Form

Welcome to the TRIGGER University's Protection Plan Interest Form

#WeArePrevention
44Questions
  • 1
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  • 2
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  • 3
    Full name of youth applying for TRIGGER University
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  • 4
    Do you have a nickname?
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  • 5
    We listen and we don't judge! Ex: Ms. Tia's zodiac is a Cancer and her toes cross - that's why she is so lucky!
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  • 6
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    Pick a Date
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  • 7
    How old are you today?
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  • 8
    Share your Zelle, PayPal, $CashApp or how we can send a stipend.
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  • 9
    We no longer use $CashApp and need another way to pay youth
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  • 10
    If your contact information ever changes please contact us.
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  • 11
    Type 444-444-4444 if you do not have a working cell service
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  • 12
    If your cellular service is out of service
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  • 13
    We will need this to deliver donations or send transportation, etc
    Please Select
    • Please Select
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curaçao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • United States
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
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  • 14
    Please Select
    • Please Select
    • Not school age (0-3years old)
    • Not school age but needs childcare (0-3years old)
    • Elementary School Student
    • 6th Grade
    • 7th Grade
    • 8th Grade
    • Freshman - 9th Grade
    • Sophomore - 10th Grade
    • Junior - 11th Grade
    • Senior - 12th Grade
    • Freshman - College
    • Sophomore - College
    • Junior - College
    • Senior - College
    • Grad Student
    • Trade Student/Education Program
    • I am not in school but I completed High School
    • I am not in school but I wish to enroll again
    • I am not in school but I did not complete High School
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  • 15
    Write N/A if you are not enrolled.
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  • 16
    At TRIGGER, we treat gun violence as a disease. Please share your level of exposure to gun violence so we can bet support you. Exposure could be seeing, hearing, losing people to gun violence.
    Please Select
    • Please Select
    • No Exposure (I feel gun violence has never impacted me)
    • Low Exposure (I feel gun violence has impacted me a little - I read/hear about gun violence)
    • Medium Exposure (I feel gun violence has impacted me moderately - I have seen gun violence)
    • High Exposure (I feel gun violence has impacted me greatly - I have lost a loved one)'
    • Infected (I have been directly in front of or behind the gun)
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  • 17
    We want to know as much as we can so we can advocate for your support
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  • 18
    Example: Adult Large or Youth Small
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  • 19
    Example: Adult Large or Youth Small
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  • 20
    US Shoe Size (Men's + Women and/or Kid Size)
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  • 21
    Example: Medium (6-8)
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  • 22
    Share your goals
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  • 23
    Tell us how to best support you
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  • 24
    Upload a SELFIE or your Student ID - NO one public will see it :)
    Drag and drop files here
    Select files to upload
    Max. file size: 10.6MB
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  • 25
    As a TRIGGER University student, I hereby pledge to prevent gun violence to the best of my ability and knowledge with The T.R.I.G.G.E.R. Project.
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  • 26
    This question is for youth 17 years old or younger. If your answer is no then please continue on with the application and we will contact you.
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  • 27
    Do you feel you have the tools to meet your goals?
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  • 28
    Check ALL that apply
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  • 29
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  • 30
    If you are 17 years old or younger, please share the name of the adult responsible for your well-being (even if you may not live with them). If you are 18 or older, please type the name of emergency contact.
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  • 31
    If you are 17 years old or younger, please share the phone number of the adult responsible for your well-being (even if you may not live with them). If you are 18 or older, please type the number of your emergency contact.
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  • 32
    If you are 17 years old or younger, please share the email or iCloud of the adult responsible for your well-being (even if you may not live with them). If you are 18 or older, please type the email of your emergency contact.
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  • 33
    Example: Grandma, 56 years old, Needs groceries
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  • 34
    Who can TRIGGER University work with to support you? Put Tia if she is your mentor but try to think of one more person for emergency contact.
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  • 35
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  • 36
    Please share adult information that we can contact during an emergency
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  • 37
    Please Select
    • Please Select
    • School Visit
    • Past Participant
    • Community Event
    • News/Media
    • Flyer
    • Google
    • Social Media
    • Friend
    • Mentor
    • Other
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  • 38
    During the summer, you will be expected to join us in-person on all working days to learn how gun violence impacts you, your community, and gain the tools to prevent the spread.
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  • 39
    Examples: Sports, Arts, Speaking
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  • 40
    Examples: Stress, trauma, peer pressure, grief
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  • 41
    When TRIGGER gets invited to events - we want you to join us. When is the best time for you? Ex: Saturdays mornings and Tuesday evenings are best.
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  • 42
    Anything you did not have a chance to share?
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  • 43

    Photographic & Youth Participation Release

    I hereby acknowledge that the information given above is accurate and I give permission to the organiation for the use of my photographs that are taken by staff in order to use for social media.

    I, too, consent to the youth's participation in the gun violence prevention activities, duties, transportation, and research coordinated by The T.R.I.G.G.E.R. Project.

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  • 44
    If you are under 18, please get parent/guardian consent.
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