Apply for the SPLC Alabama Youth Council

Name (Applicant)

First Last

Are you under 18 (and have a parent/guardian's permission to participate)?(Required)

Yes

Age(Required)

Email(Required)

Phone(Required)

Parent/Guardian Name(Required)

First Last

Parent/Guardian Email Address(Required)

Parent/Guardian Phone Number(Required)

County(Required)

School (Current/Former)(Required)

Do you have access to transportation?(Required)

Yes

Were you referred to this program?(Required)

Yes

If so, who referred you?

What does “community” mean to you?(Required)

What issues in your community mean the most to you?(Required)

What do you hope to gain from participating in this program?(Required)

Do you anticipate any barriers to participation? (work schedule, child care, transportation, etc.)(Required)

Yes

If yes, please note any potential barriers (maybe we can help!)

How would you engage other youth or community members in this program?(Required)

Do you consent to being photographed or recorded during Youth Council events for promotional or educational purposes?(Required)

Yes

Please download and fill out this media release form to present in person, or upload completed document in the space below.

Upload completed media release form.

Max. file size: 50 MB.

Do you have any accessibility needs or accommodations to ensure your participation? Please list or describe them below, if applicable.

Finally, is there anything else you'd like us to know about you?

This field is for validation purposes and should be left unchanged.

Together We Fight