Thank you for your interest in Youth and Parent programs through the  Eagle River Youth Coalition. If you are applying for the Youth Leaders Council, the 2018-2019 council has already been selected, we will review any new application in May 2019 and respond to you at that time.  If you are registering for an ERYC Family Program (Families in Action or Eat Chat Parent), please choose the ERYC program application and register all family members that will be attending a class. We will contact you soon with program details. Should you have any questions, please contact info@eagleyouth.org or 970-949-9250.

Gracias por su interés en los programas de jovenes y padres con el  Eagle River Youth Coalition.  Si quiere hacer la aplicación por Youth Leaders Council, el consejo de la juventud ya está elegido por el año 2018-2019, revisaremos las aplicaciones nuevas de los jóvenes en mayo 2019 y responderemos en este tiempo.  Si quiere hacer la matriculación por los programas familiares de ERYC (de Familias en Acción o Eat Chat Parent), por favor elegir la aplicación de ERYC programas abajo y hacer la aplicación por todos los miembros de su familia quien va a asistir las clases.  Si tiene alguna pregunta, llame al 970-949-9250 o info@eagleyouth.org.

* Required field

Select Application
* What are you applying for?
* Which program are you applying for?
* Please specify other program:
Basic Information
* First Name
Middle Name
* Last Name
* Email
Cell Phone
Home Phone
Marital status
School Information
Current Grade
Current School
Grade Next School Year
School Next School Year
Year of Expected Graduation From High School
Demographic Information
* Date of Birth
* Gender
* Ethnicity
* Race
* Other race:
* Language spoken in the home
Other language spoken proficiently
* Other language:
Home Address
* Home Address 1
Home Address 2
* Home City
* Home State
* Home Zip Code
Mailing Address
* Mailing Address 1
Mailing Address 2
* Mailing City
* Mailing State
* Mailing Zip Code
Business Information
Business Name
Business Address 1
Business Address 2
Business City
Business State
Business Zip Code
Youth Leaders Council Short Answer Questions
* What youth voice would you represent on the council? (ie: athletics, hobbies, clubs, race, ethnicity, gender, sexual orientation, grade level, etc.)
* What organizations, clubs, programs are you currently involved with or plan to be come involved with?
* What do you currently know about the Youth Leaders Council?
* What are your strongest leadership skills and what are your current personal development goals?
* How will you use your leadership skills to improve the community? What do you see as a pressing need for youth and how would you like to impact positive change?
* What excites/interests you about the opportunity to be a part of the Youth Leaders Council?
* If you have been a participant in YLC, what do you think has been your greatest contribution?
What are you hobbies and passions?
Emergency Contact Information
* Emergency Contact Name
* Emergency Contact Phone
* Emergency Contact Relationship
Reference Information
* Reference Name
* Reference Phone
* Reference Email Address
* How do you know this reference?
Family Information
* Do you have children?
Yes
No
* How many children do you have?
* What are your children's ages?
* What school(s) do your children go to?
Program Information
* How did you find out about our program?
Which of the following programs have you or your child (if you have children) participated in?
Are you requesting partial scholarship to attend the program?
Please explain why you are requesting a scholarship to attend the program.
Photo Release & Newsletter
Photo
No file is currently uploaded.
Upload File
* I approve Eagle River to use my photo/video for organization marketing and awareness purposes.
* I give permission for ERYC to send me periodic updates and monthly newsletters to my email address.
Yes
No
* What types of communication would you like to receive?
Volunteer Opportunities
* Are you interested in volunteering opportunities?
* What types of volunteering opportunities are you interested in?
Skills/Interests
Additional Information
Allergies?
Special Needs?
Education Level
Preferred form of communication
Main form of transportation
Do you receive any of the following benefits?
* Please specify other benefits received: