Youth Inquiry Template

Non-Discrimination Policy

Our participants come to us with a wide range of personal characteristics. We believe that participant eligibility shall be determined without regard to race, color, religion, national origin, gender, marital status, sexual orientation, gender identity, veteran status, or disability.

Program Interest

Which Program are you interested in?

Community BasedSchool BasedUndecided

Youth Information

First Name

Last Name

Preferred Name

Birthdate

Gender	Personal Pronouns
How does the youth identify?	What pronouns does the youth use?
School	Graduation Year from High School This is the year the youth will graduate.

School Account ID

Race/Ethnicity

American Indian or Alaska NativeAsian IndianBlack or African AmericanChamorroChineseFilipinoHispanic - CubanHispanic-Mexican,MexicanAmerican,ChicanoHispanic-Other Latinx or Spanish originHispanic - Puerto RicanJapaneseKoreanMiddle Eastern or North AfricanNative HawaiianOtherOther AsianOther Pacific IslanderPrefer not to saySamoanSome other race or originVietnameseWhite or Caucasian

Guardian's Relationship to Youth

The parent/guardian is this child's

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Mobile Phone

Personal Email

I prefer to be contacted by

Family Information

Mailing Street Address

Mailing City

Mailing State

Mailing Zip Code

If you have any issues submitting your inquiry please contact us:

Email: alyssa@foundationforyouth.com

Call: 812.348.4558 and leave a message with Customer Service

We will get back with you as soon as someone is available.

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Contact Information