What Is the Summer Youth Leadership Institute?

What is the Summer Youth Leadership Institute?

A four day event for teens residing in Holyoke or Springfield, the 2011 Summer Youth Leadership Institute is for those who want to know more, and have something to say, about sex, sexually transmitted infections, and pregnancy. Participants will develop leadership and advocacy skills totake action and create change in their communities with regards to teen pregnancy, sexual health, and healthy relationships. The institute is FREE, but there is an application process.

Who Should Apply?

Any person between the ages of 13-19 who lives in Holyoke or Springfield who is interested in becoming more involved with the topics of healthy relationships, teen pregnancy, sexual health and social change. You should also be able to attend all four days of the training. There are only 15 spots—All applications will be given thoughtful consideration, but only 15 will be accepted.

When and Where is the Institute?

August 16th-19th at Holyoke Community College from 9 a.m.-4 p.m.

What about Transportation?

There will be a bus pick-up and drop-off location for both Holyoke and Springfield. Exact locations TBD.

How Do I Apply?

Please complete the following application as thoroughly and honestly as you can. Applications must be submitted by July 25, 2011. You can submit applications via email, fax, or regular mail. Mail completed applications to:A. Tommy Thompson, YEAH! Network, 4 Open Square Way, Suite 415, Holyoke, MA 01040. (See above for email address & fax.)

Application

2011 Summer Youth Leadership Institute

Tuesday August 16, 2011-Friday August 19, 2011

(Please type or print clearly)

Name (preferred):

Address: (street)(apt. #)

(city)(state)(zip code)

Your Birthday: Your Place of Birth:

Parent/Guardian Name:Phone Number:

Your E-Mail Address:

Your PhoneNumber:

What is the best way to contact you?

School you Attend(if any):

Grade you will be in Next Year (circle one):

9th 10th 11th 12th GED

Have you ever participated in any YEAH! Network Program? If yes, when and where?

How did you learn about the Youth Leadership Institute?

T-Shirt Size (circle one):

S M L XL XXL

To ensure diversity at the Youth Leadership Institute, please circle any of the following that apply to you.

It is important that you check at least one box in each section. This information is confidentialand will not be disclosed or used for any other purposes.

a) RACE (please circle all that apply)

African American/Black

Asian / Asian American

Biracial/Multiracial

Please specify:

Indigenous/American Indian/ Native American

Please specify:

Jewish

Latino (a) / Hispanic / Chicano (a)

Middle Eastern

Pacific Islander

South Asian (Indian, Pakistani, Sri Lankan, Tibetan, etc.)

White, Caucasian, European American

Self-Identified:

b) RELIGIOUS IDENTIFICATION:

c) GENDER IDENTITY

WomanMan Transgender/Gender VariantSelf-Identified:

d) SEXUAL ORIENTATION (Please circle all that apply)

Heterosexual Gay Bisexual Lesbian Pansexual Queer

Questioning Self-Identified:

e) DISABILITIES

Yes No

If yes please list:

Please answer the following questions. Feel free to use the back of this page or additional paper as necessary. (Please type or print clearly):

1)Why are you interested in participating in the Summer Youth Leadership Institute?

2)What other youth projects are you involved in?

3)Why should teens be learning about sexual health and healthy relationships?

4)How has teen pregnancy affected you or your community?

5)If you were stranded on a desert island and you could only have 2 things with you, what would they be? Why?

6)Is there anything else you want to share about yourself?

Thanks for your interest in the 2011 Summer Youth Leadership Institute!