Youth Inquiry

Youth Inquiry

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. You must complete a separate Youth Inquiry Form for each Little you are enrolling.

Youth Information

Child's First Name

Child's Last Name

Child's Preferred Name

Child's Birthdate

Child's Gender	Child's Personal Pronouns (Optional)
How does your child identify?	What pronouns does your child use?
Child's School	Child's Graduation Year from High School This is the year the youth will graduate.

Child's Social Security Number

Please leave out dashes when entering SSN

Child's 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

Parent/Guardian Employer (Employer name or NA)

I prefer to be contacted by

Family Information

Which community are you enrolling your youth in?

Mailing Street Address

Mailing City

Mailing State

Mailing Zip Code

Parish:

Referral Detail ID

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Contact Information