Youth CAUSE Initiative Application Form

Youth CAUSE Initiative 2022 Application Form

Please complete the online "Youth CAUSE Initiative form" below by MONDAY 9 MAY 2022. NO PAPER COPIES WILL BE ACCEPTED. For questions please contact Dr. Rob at rob@ysa.world.

Applicant Details

* Indicates required field

Youth CAUSE Initiative Applicant Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Date of Birth *

I identify my gender as: *

Participant Phone Number *

School enrolled for 2022-23? *

Grade level for the 2022-23 school year? *

Parent/Legal Guardian Details

Please complete this section if participant is 18 years of age or younger.

Parent/Legal Guardian Name #1 *

First

Last

Parent/Legal Guardian Name #2 (Optional) *

First

Last

Best Parent Phone Number *

Parent Email #1 *

Parent Email #2 *

Application Timeline & Program Expectations

The following timeline will be used when considering applications:

November 18, 2021 - Applications open
February 14, 2022 - Final day for applications
Early March 2022 - Ambassador candidates invited for interviews
May 9, 2022 - Earth Day - Successful applicants announced for summer 2022 program
July-Aug 2022 - 2022 Youth CAUSE Initiative Programs

Please check the boxes for the weeks the participant will be attending the Youth CAUSE Initiative workshops. Workshops run Monday through Friday. Note that attendance is mandatory for workshops of Aug 1-5 and Aug 8-12 in order to participate in the Youth CAUSE Initiative program.

If selected for the program, I will be participating in the following weeks of the Youth CAUSE Initiative program (Min. 4 weeks to be selected): *

July 7-8: Youth CAUSE Orientation July 12-15: Intro to Coding & Technology Week July 19-22: Climate Science Week July 26-29: Science Communication Week Aug 1-5: Hackathon Week Aug 8-12: Media Week

Application Questions

Please provide brief answers (no more than 5 sentences) to the following questions:

Why do you want to be a youth ambassador? *

What interests you about science? *

What is the most important topic that needs to be solved in Wilmington? *

Pick-up and School Transportation Planning

We have designed our program to be flexible and to accommodate participants that attend traditional and year round schools. No one is going to miss out on opportunities to experience science. We will be open Tuesday through Friday from 8a to 4p with the occasional Saturdays reserved for family field trips (to be confirmed). For those Ambassador participants that do not have access to transportation, we are able to provide home pick up and drop off as well as school pickup.

Please indicate your transportation needs below. Spaces are limited but we will do everything to accommodate all needs of the youth:

My child will require pickup from his/her residence each day between 7.30-9a: *

Yes No

My child attends a year-round school and will require school pickup: *

Yes No

My child will require drop off at his/her residence at the end of each day: *

Yes No

Acknowledgement

Digital signature of parent or guardian *

relationship to student *

date *

I agree to receiving marketing and promotional materials

Submit