Youth In Action Application

Our Youth in Action (YIA) program supports youth in activating their leadership and community advocacy skills.

Members will:

Learn about various social issues impacting the community
Connect with local organizers, activists, artists, and political figures to learn more about various lenses of social justice topics
Build resume skills and network with local community leaders
Receive a stipend of $15 per hour

Requirements:

Be grades 9-12 in 2022-2023 school year
Complete the application
Commit to attending meetings at location once a week for 2 hours each
Have a brief phone conversation about your interest with one of our counselors

2022-2023 Session Details:

Sessions occur weekly beginning Wednesday, Nov. 9, 2022
Time: 4:00 – 6:00 pm
Location: YWCA Downtown Board Room, 1130 Nicollet Ave, Minneapolis, MN 55403

Questions? Contact us at ContactPlus@ywcampls.org or 612-215-4372.

Youth Application Parent Form More About YIA

Youth Application

This is the youth portion of the application. Fill out the form below and click submit. Fields marked * are required.

Participant Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
School*
Grade*
Race/Ethnicity*
Gender*
Any medical conditions/allergies/dietary restrictions? (If yes, please list)*
Do you qualify for a Free or Reduced Lunch Program/Educational Benefits?*
- Yes
- No
- Not Sure
Essay Section
Would you prefer sending us a short email or having a brief call with a YIA counselor?*
- Email
- Phone call
Share why you are interested:*
Comments
This field is for validation purposes and should be left unchanged.

Save and Continue Later

Parent/Guardian Form

This is the parent/guardian portion of the application. Fill out the form below and click submit. Fields marked * are required.

Child Information
Child's Name*
First Last
Parent/Guardian Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
Relationship to Applicant*
Emergency Contact Name*
First Last
Emergency Contact Phone*
Parent/Guardian Consent
Consent*
I agree to the following statements.
1. I grant permission for my child/ward:
- To participate in all activities of YWCA youth programs
- To participate in program field trips under proper supervision
- To ride in authorized YWCA vehicles for program activities
- For the YWCA Youth Program Counselor to obtain information on my child’s/ward’s academic and attendance records

2. I understand that programs may contain information on sexuality and other health-related issues and I give my
child/ward permission to participate.

3. I agree that neither YWCA nor any other person associated with them has any responsibility to me or to my
child/ward for any claims arising from accident, health or medical treatment.

4. I understand that any expenses incurred under item 3 will be the sole responsibility of the child’s/ward’s family.

5. I understand that YWCA staff and volunteers are Mandated Reporters. If abuse or neglect is suspected, YWCA staff
and volunteers are required by Minnesota law and YWCA policies to place a report to Child Protection Services.

6. I hereby authorize YWCA staff to give my child/ward reasonable first aid and to transport my child/ward to a health care facility for emergency services as needed. I have read the above terms and agree to them while my child/ward is a participant in YWCA Minneapolis youth programs.
By typing my full name in the box below, I consent to the above. This is equivalent to my signature.*
Date*
MM slash DD slash YYYY
Publicity Consent
Consent
I hereby grant voluntarily and without monetary compensation the YWCA of Minneapolis permission to:
- Make video and audio recordings of me and/or my voice.
- Take and use photographs of me and/or my family.
- Record, use, display and disclose in a video and/or other media intended for public consumption statements and/or information provided by me concerning myself and/or my family.
- Use the activities listed above for direct mail, advertising, public relations, website, email, social media (e.g., Facebook, Twitter, etc.) and other online efforts related to the YWCA of Minneapolis.
- Use my name and the names of members of my family in conjunction with the activities listed above.

With respect to the above, I relinquish to the YWCA of Minneapolis all rights, title and interest I may have in all originals, edited versions, reproductions, and copies of any video and/or audio recording(s), prints, negatives, digital images and photographs in which my or members my family’s name, image, statements, information, and/or voice is used (the “Materials”).

I also irrevocably grant the YWCA of Minneapolis permission to copyright, if applicable, the Materials, and to use, reuse, copy, publish, display, exhibit, reproduce, license to a third party, and distribute the Materials in any manner and for any reason the YWCA of Minneapolis may deem proper, including the right to use the same for purposes of advertising or trade.

By signing this Publicity Consent Release, I acknowledge that the YWCA of Minneapolis is not responsible for the
unauthorized use of the Materials by unrelated third parties. I hereby release the YWCA of Minneapolis from liability for any damages that may arise from the unauthorized use of the Materials by a third party.

NOTE: If you should no longer like the YWCA of Minneapolis to use your image in its awareness and education materials and activities, please contact the YWCA of Minneapolis. Due to the distribution and printing timelines, some of the materials the YWCA of Minneapolis may not be able to remove your image immediately from its pieces, but will do so as soon as those print pieces are scheduled for reprinting or new production. Print materials that are distributed to public audiences may not be recalled once distributed. Materials used for emails, website, social media or other online efforts may be removed from YWCA sites and networks, but due to the nature of the internet, may remain available online through other sources indefinitely.
Name of Minor Child
Name of Minor Child
Name of Minor Child
By typing my full name in the box below, I consent to the above for the child(ren) listed. This is equivalent to my signature.
Date
MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.

Save and Continue Later

Youth In Action Application

Youth In Action Application

Members will:

Requirements:

2022-2023 Session Details:

Youth Application

Participant Information

Essay Section

Parent/Guardian Form

Child Information

Parent/Guardian Information

Parent/Guardian Consent

Publicity Consent