Leaders of the New School, Orange County (2018 High School)

Personal Information

First Name

Last Name

What is your preferred gender pronoun? (ie. He/Him, She/Hers, They/Them)

He/Him/His, She/Her/Hers, They/Them/Theirs, etc

Birth Date (format as 10/20/1999)

month/day/year

Race/Ethnicity

Asian American / Pacific Islander

Korean

Latino

Black

White

Other

(Optional) Name in Korean characters

Phone Number

Would you like to receive KRC email newsletters?

Yes

Address

Street Address

City

State

ZIP Code

County

Emergency Contact

Relationship to you

Parent

Relative

Friend

First Name

Last Name

Cell Phone

School

Existing Contact

If you are unable to find your school, type your school name here:

What year are you currently in school?

Program Questionnaire

Tell us about yourself. Include your background, interests, and leadership experiences.

Why are you interested in this program?

What are some social justice issues that you are most passionate about? Do you have experience with any type of social justice related work?

Where do you see yourself in a year? In five years?

Logistical Information

How did you hear about KRC?

Online (Search)

Link on another website

Mass Media

Someone told me about KRC

I already knew KRC

Flyer

Other

Presentation Outreach

Class Rep (Organizers)

If other, please describe

Do you have dietary needs/restrictions? If so, please describe

Do you have any medical conditions or mental health concerns that we should be aware of?

Are there any accessibility needs or accommodations that KRC can assist with?

Do you have a means of transportation?

Our meetings will take place in Orange County.

Agreement

Please check the boxes to indicate your agreement with the below:

Are there any scheduling conflicts?

Commitment to the program is required and missing any day is highly discouraged.