Qualtrics Survey | Qualtrics Experience Management

Student form

This form is for the Youth Advocacy Summit for youth in grades 7-12 on October 16-17, 2024, sponsored by Missouri AfterSchool Network, and supported by your afterschool program. To participate, you must be enrolled or regularly attend an afterschool program. We thank you for your interest and are excited for you to participate in this program! You will stay overnight at the Capitol Plaza Hotel in Jefferson City for an advocacy and leadership training, capitol tour and more. At least one staff member from your afterschool program will also be there. The information you provide in this form will help us provide the best possible experience for you. Please complete the entire form. Your parent or guardian will fill out a separate form. Thank you!

Your information

First name (your preferred name)

Last name

Gender

Your cell phone number, if you have one. We will only contact you directly with the permission of your parent/ guardian.

In order to participate you must be in grades 7-12. What grade are you in?

In order to participate, you must also regularly attend an afterschool program. What is the name of your afterschool program?

You will be sharing a hotel room with other youth. When we are assigning hotel rooms, is there anything you want us to know?

Writing section
We would like you to write a one paragraph response to two of the following questions. Please choose the two questions you would like to respond to.

Why is it important to speak up on behalf of other youth (advocacy)?
Why do you want to share with others about how important your afterschool program is?
What does it mean to be involved in your community and why is this important?
What do you wish people in power would do to help more youth succeed?
What are you passionate about that helps other people?

Please write a paragraph to respond to the first question you chose in the writing section.

Please write a paragraph to respond to the second question you chose in the writing section.