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I'm ready to make a change!

Name *
(If it's summer, the grade you will be in this fall.)
Youth applicant's birthday *
Youth applicant's birthday
Youth Applicant's Phone #
Youth Applicant's Phone #
(if you don't have a phone just leave this blank)
Parent/Guardian Name *
Parent/Guardian Name
Parent/Guardian's Phone # *
Parent/Guardian's Phone #
And now for a lot of questions about you and your life. Please be honest. Thanks.
There is a lot of conflict in my family *
Have you ever failed a class in school? *
I use drugs and/or alcohol *
Are you eligible for free or reduced lunch? *
Would you describe yourself as a person that gets into a lot of trouble? *
Have you ever been in trouble with the law? *
Have you ever been in a residential treatment facility? *
Does your family have a history of getting into trouble? *
Have you ever been suspended or expelled from school? *
In your opinion, do your parents (guardians) do a good job raising you? *
How will BYEP be better because you are part of it?
If no, simply type nope.