Positive Youth Action (+YA) Online Application

Emergency Contact Information
Please list your emergency contact's name.*

First NameLast Name
What is the Phone Number for your emergency contact?*
Please enter a valid phone number.

Expectations and Commitments

Successful completion of the +YA program – and fully benefiting from it – requires individual participant commitment to:
Attend: Weekly meetings whether in-person or online, as well as a 1-1 meeting with the Youth Program Specialist once each month. You will also be given a calendar of community events and asked to attend a portion of them as best works with your schedule.*

I Agree
Reflect: Short online assignments will be required from time-to-time. Participation in these online discussions helps process learned information and contributes to the cohort as a whole.*

I Agree
Communicate: Participants must communicate via email and online learning software with the Youth Program Specialist and their Peers in the cohort on a regular basis.*

I Agree
Respect: All communications and class time will honor the time of everyone involved by arriving promptly, participating respectfully, and taking care to never monopolize conversation. Participants must be willing to honor the stated boundaries of others and be clear about their own boundaries.*

I Agree

Short-Answer Questions (1-2 Paragraphs)

Just answer them as honestly as you can – we are simply looking for a representation of who you are and why you want to be a part of this Leadership Development Program.
Tell us about a space you've been in or an experience you have had that could have been improved through Youth/Young Adult Leadership:*
What does a Mentor look like to you?*
What does a Leader look like to you?*
What is HIV Stigma and how has it affected you/your peers?*
What are your goals, and why do you want to be a part of +YA?*

Last Question!
If I am selected for an interview, it would be best to:*

Call me to notify meEmail me to notify me

Submission Page
Today's Date:

MonthDayYear
Date
{whatIs}

I understand that I may not be selected for this round of +YA, but that I can apply again for future cohorts. If I am not selected, it does not mean that I was not a good candidate, but simply that there were many applicants and only a select number (10) who can participate each cycle. If I am not selected this time and want to know how I could improve my application next time, I can contact the Youth Program Specialist, Nick Atkinson at natkinson@damien.org.
Should be Empty:

Damien Center