Youth Empowerment Program Application

Program Young Women at the Helm
Young Men at the Helm
Advanced Young Women at the Helm

* First Name

* Last Name

* Address

* City

* State

* Zip

* Email

* Cell Phone

* Home Phone

* Birthdate

* Gender Male
Female

* School / Organization

* Please give us the name, email address and phone number of an adult or teacher from your school or organization that we can contact as a reference.

What are you interested in? What do you like to do for fun?

Have you sailed onboard Clearwater before? If yes, when?

What are two things about yourself you would like to improve?

What is a particular challenge you have faced and overcome, or would like to overcome, in your life?

What are two strengths or skills you possess?

What would you like to get out of your experience on Clearwater?

Fish & Plankton (select) 1 2 3 4

Water Quality & Env. Justice (select) 1 2 3 4

Maritime Skills & Sailing (select) 1 2 3 4

Navigation & Engineering (select) 1 2 3 4

Do you consider yourself a leader? What skills or characteristics do you think are required to be a good leader?

Have you ever been camping before?

Describe something you care about or are proud of in your life.

What would you like to do in your life if you had no limits?

What is your estimated annual household income?

What elementary and middle schools did you attend?

What is your ethnicity?

What is your first language?

How did you hear about Clearwater's Youth Empowerment Programs?