Please fill out information below: Person completing this form: YOUR relationship to the Youth *PARENTLEGAL GUARDAINFAMILY FRIENDSELF (I am 18 years or older am consenting myself) Person completing this form: Contact Information Participant Name * Gender *Female Male Doesn’t Identify Other Race/Ethnicity *White, non-Hispanic/LatinoBlack, non-Hispanic/LatinoAsian, non-Hispanic/LatinoAmerican Indian/Alaska Native, non-Hispanic/LatinoNative Hawaiian/Other Pacific Islander, Non-Hispanic/LatinoMore than one race/ non-Hispanic/LatinoRace unknown/not reported, non-Hispanic/LatinoWhite, Hispanic/Latino What is the Youth AGE *13-1415-1617-1819+ What GRADE is the Youth in *7-89-1011-12other Street Address * Apartment, suite, etc City * State/Province * ZIP / Postal Code * Email Address * Phone Number Parent: Contact Information Name Email Address * Phone Number * How would you like to participate? Love Notes 3.0 SRA Curriculum ImplementationThese individuals will participate in 13 Love Notes curriculum implementation lessons which takes about 45 minutes to implement. Youth Community Change Commission (YC3)To represent the Youth Voice. These individuals will participate in training and technical assistance on the basic tenants of Social Justice and Youth Participatory Action Research (YPAR). Youth Participatory Action Research (YPAR) is a community-based social justice research framework that inclusively supports the leadership and knowledge of youth most impacted by disparities to develop solutions for social, cultural, and political transformation. Youth have any allergies? If so, please list: How did you hear about us? * Send Registration
