2. First Name*
3. Middle Name
4. Last Name*
6. Preferred Pronoun:
8. Address*
10. City
11. State
12. Zip Code
14. Phone Number*
15. Email Address*
17. Current Grade
19. Do you have a copy of the book "The Moment: Changemakers on Why and How They Joined the Fight For Social Justice" by Steve Fiffer?

    You do not need to own the book to be admitted to the Youth Leadership Academy Fall 2023 - we just want to know if you already own it!

21. Area(s) of Interest

    (please check all that apply):

    1. Human Trafficking
    2. Intersection between Domestic Violence & Human Trafficking
    3. All Areas of Discrimination
    4. Discrimination in Employment
    5. Discrimination in Education
    6. Discrimination in Law Enforcement

    1. Discrimination in Public Accommodations
    2. Discrimination in Residential Real Estate (Housing)
    3. Discrimination in Commercial Real Estate
    4. Social Justice/Civil Rights
    5. Language Access
23. How many hours in a week can you commit to the virtual Youth Leadership Academy?

    Fall 2023 will run for five virtual sessions of one hour each and will also require some amount of out-of-session work for you at home while you research areas of interest to you and look for inspiration from others.

25. Please provide a maximum one-page response (be creative!) to one of the following questions:

    1. In a perfect world, what does social justice look like?
    2. If you were given $1 million, what would you do with it?
    3. Describe your perfect job/career and why.
27. In a perfect world, what does social justice look like?
29. If you were given $1 million, what would you do with it?
31. Describe your perfect job/career and why.
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33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

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